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The Prognostic Ability of Log Odds of Positive Lymph Nodes in Oral Cavity Squamous Cell Carcinoma.

Lee CC, Ho HC, Su YC, Lee MS, Hung SK, Chen YL - Medicine (Baltimore) (2015)

Bottom Line: Cox proportional hazards models were used to compare the disease-specific survival (DSS) rates for pN, rN, and LODDS after adjusting for possible confounding risk factors.The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803).In our series, LODDS shows great promise as a prognostic tool for OSCC.Compared with the AJCC pN classification and the rN classification, LODDS can stratify OSCC patients and help to identify high-risk patients missed by the other systems.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (C-CL, H-CH); School of Medicine, Tzu Chi University, Hualian, Taiwan (C-CL, H-CH, Y-CS, M-SL, S-KH); Division of Hematology-Oncology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (Y-CS); Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (M-SL, S-KH); and Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (Y-LC).

ABSTRACT
Recently, log odds of positive lymph nodes (LODDS) was proven a better prediction of outcomes than other methods in gastric cancer, pancreatic cancer, and colon cancer. However, the validity is not yet tested in oral cavity squamous cell carcinoma (OSCC). We conducted a retrospective study to compare the predictive ability of LODDS, traditional pN classification and lymph node ratio (rN) in OSCC patients.In total, 347 OSCC patients receiving surgery with or without adjuvant therapy at the time of diagnosis between 2004 and 2013 were identified from the cancer registry database of the Dalin Tzu Chi Hospital. Cox proportional hazards models were used to compare the disease-specific survival (DSS) rates for pN, rN, and LODDS after adjusting for possible confounding risk factors. The discriminatory ability of different classification systems was evaluated using the adjusted hazard ratio and Akaike information criterion (AIC) by multivariate regression model. The prediction accuracy of the model was assessed by Harrell's c-statistic.The 347 OSCC patients had a mean age of 57 years old. Among them, 322 patients (92.8%) were male and 189 patients (54.5%) were in stages III to IV. LODDS showed better discriminatory ability for patients with <5 pathological cervical metastatic nodes and those with rN < 0.2. The hypothetical T-LODDS-M staging system had higher linear trend Chi-square, lower AIC, and higher prediction accuracy compared with the American Joint Committee on Cancer (AJCC) TNM, or hypothetical T-rN-M system. After adjusting for other factors, the LODDS unfavorable group had the highest adjusted hazard ratio (HR, 5.42; 95% confidence interval [CI], 3.19-9.12) and LODDS-based model lowest AIC of 704, comparing with pN and rN-based model. The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803).In our series, LODDS shows great promise as a prognostic tool for OSCC. Compared with the AJCC pN classification and the rN classification, LODDS can stratify OSCC patients and help to identify high-risk patients missed by the other systems.

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The adjusted disease-specific survival (DSS) curves for pN, rN, and LODDS with 2 categories. After adjusting for age, gender, comorbidity, pathological T classification, margin status, differentiation, tumor site, the difference in DSS between the favorable and unfavorable classification in LODDS system (C) (adjusted HR, 5.42) was the most significant, compared with pN (A) (adjusted HR, 4.19) and rN (B) (adjusted HR, 2.71) systems.
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Figure 4: The adjusted disease-specific survival (DSS) curves for pN, rN, and LODDS with 2 categories. After adjusting for age, gender, comorbidity, pathological T classification, margin status, differentiation, tumor site, the difference in DSS between the favorable and unfavorable classification in LODDS system (C) (adjusted HR, 5.42) was the most significant, compared with pN (A) (adjusted HR, 4.19) and rN (B) (adjusted HR, 2.71) systems.

Mentions: In order to make the model more stable, we merged the 4-category classification of cervical neck nodes into favorable and unfavorable (pN0–1 vs. pN2–3, rN0–1 vs. rN2–3, and LODDS 0–1 vs. LODDS 2–3, respectively). The adjusted DSS curves for the LODDS classification had better discrimination than the pN and rN classifications (Figure 4). In multivariate regression analysis, we compared the prognostic impact of pN, rN, and LODDS after adjusting for age, gender, comorbidity, pathological T classification, margin status, differentiation, and tumor site (Table 5). We used the adjusted HR and AIC to evaluate the discriminatory ability of each classification. LODDS had the highest adjusted HR (HR, 5.42; 95% CI, 3.19–9.12) and the LODDS-based model had lowest AIC value (704). The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803). The above-mentioned data indicated that LODDS is a superior classification system for OSCC compared to either pN or rN.


The Prognostic Ability of Log Odds of Positive Lymph Nodes in Oral Cavity Squamous Cell Carcinoma.

Lee CC, Ho HC, Su YC, Lee MS, Hung SK, Chen YL - Medicine (Baltimore) (2015)

The adjusted disease-specific survival (DSS) curves for pN, rN, and LODDS with 2 categories. After adjusting for age, gender, comorbidity, pathological T classification, margin status, differentiation, tumor site, the difference in DSS between the favorable and unfavorable classification in LODDS system (C) (adjusted HR, 5.42) was the most significant, compared with pN (A) (adjusted HR, 4.19) and rN (B) (adjusted HR, 2.71) systems.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4504633&req=5

Figure 4: The adjusted disease-specific survival (DSS) curves for pN, rN, and LODDS with 2 categories. After adjusting for age, gender, comorbidity, pathological T classification, margin status, differentiation, tumor site, the difference in DSS between the favorable and unfavorable classification in LODDS system (C) (adjusted HR, 5.42) was the most significant, compared with pN (A) (adjusted HR, 4.19) and rN (B) (adjusted HR, 2.71) systems.
Mentions: In order to make the model more stable, we merged the 4-category classification of cervical neck nodes into favorable and unfavorable (pN0–1 vs. pN2–3, rN0–1 vs. rN2–3, and LODDS 0–1 vs. LODDS 2–3, respectively). The adjusted DSS curves for the LODDS classification had better discrimination than the pN and rN classifications (Figure 4). In multivariate regression analysis, we compared the prognostic impact of pN, rN, and LODDS after adjusting for age, gender, comorbidity, pathological T classification, margin status, differentiation, and tumor site (Table 5). We used the adjusted HR and AIC to evaluate the discriminatory ability of each classification. LODDS had the highest adjusted HR (HR, 5.42; 95% CI, 3.19–9.12) and the LODDS-based model had lowest AIC value (704). The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803). The above-mentioned data indicated that LODDS is a superior classification system for OSCC compared to either pN or rN.

Bottom Line: Cox proportional hazards models were used to compare the disease-specific survival (DSS) rates for pN, rN, and LODDS after adjusting for possible confounding risk factors.The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803).In our series, LODDS shows great promise as a prognostic tool for OSCC.Compared with the AJCC pN classification and the rN classification, LODDS can stratify OSCC patients and help to identify high-risk patients missed by the other systems.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (C-CL, H-CH); School of Medicine, Tzu Chi University, Hualian, Taiwan (C-CL, H-CH, Y-CS, M-SL, S-KH); Division of Hematology-Oncology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (Y-CS); Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (M-SL, S-KH); and Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (Y-LC).

ABSTRACT
Recently, log odds of positive lymph nodes (LODDS) was proven a better prediction of outcomes than other methods in gastric cancer, pancreatic cancer, and colon cancer. However, the validity is not yet tested in oral cavity squamous cell carcinoma (OSCC). We conducted a retrospective study to compare the predictive ability of LODDS, traditional pN classification and lymph node ratio (rN) in OSCC patients.In total, 347 OSCC patients receiving surgery with or without adjuvant therapy at the time of diagnosis between 2004 and 2013 were identified from the cancer registry database of the Dalin Tzu Chi Hospital. Cox proportional hazards models were used to compare the disease-specific survival (DSS) rates for pN, rN, and LODDS after adjusting for possible confounding risk factors. The discriminatory ability of different classification systems was evaluated using the adjusted hazard ratio and Akaike information criterion (AIC) by multivariate regression model. The prediction accuracy of the model was assessed by Harrell's c-statistic.The 347 OSCC patients had a mean age of 57 years old. Among them, 322 patients (92.8%) were male and 189 patients (54.5%) were in stages III to IV. LODDS showed better discriminatory ability for patients with <5 pathological cervical metastatic nodes and those with rN < 0.2. The hypothetical T-LODDS-M staging system had higher linear trend Chi-square, lower AIC, and higher prediction accuracy compared with the American Joint Committee on Cancer (AJCC) TNM, or hypothetical T-rN-M system. After adjusting for other factors, the LODDS unfavorable group had the highest adjusted hazard ratio (HR, 5.42; 95% confidence interval [CI], 3.19-9.12) and LODDS-based model lowest AIC of 704, comparing with pN and rN-based model. The LODDS-based system had the highest prediction accuracy for 3-year DSS (Harrell's c-statistic, 0.803).In our series, LODDS shows great promise as a prognostic tool for OSCC. Compared with the AJCC pN classification and the rN classification, LODDS can stratify OSCC patients and help to identify high-risk patients missed by the other systems.

Show MeSH
Related in: MedlinePlus