Risk Categories Predicts Disease Progression and Overall Survival for Low Stage Oral/Oropharyngeal Cancers.
Margaret Brandwein-Gensler, Yufeng Li, Shuting Bai, George Jour, Marilena Vered, Joseph Dort, Harold Lau, Carla Penner, Beverly Wang, Michael Prystowsky, Abdi Negassa. UAB, Bham; Beth Israel, NY; Tel Hashomer, Ramat Gan, Israel; U Calgary, Canada; U Manitoba, Winnipeg, Canada; NYU, NY; Montefiore, Bronx
Background: Our validated Risk Model predicts outcome for patients with oral/oropharyngeal squamous cell carcinomas (SCC). A risk score is assigned by assessing tumor worst pattern of invasion (WPOI) & lymphocytic host response (LHR) at the tumor interface, and perineural invasion. Identifying low-stage cancer patients at high-risk for disease progression (DP) could become the basis for developing new treatment protocols. We test the hypothesis that the Risk Model has added prognostic value within a low-stage patient cohort.
Design: This multi-institutional observational study was limited to patients with Stage I/II oral/oropharyngeal SCC treated by primary surgery +/- radiation. Resection specimen slides were reviewed by MBG, blinded to outcome, and the risk category assigned. The resection margin standard was 5 mm. Outcome was classified as disease progression (DP), overall survival (OS), and disease-specific survival. Univariate and multivariate Cox regression analyses were performed and Kaplan Meier survival curves were generated for these outcomes, and these variables: WPOI, LHR, PNI, score, risk category, stage, tumor site, margins, center, age, sex, and treatment. Significance was set at p ≤ 0.05.
Results: This cohort is comprised of 172 men, 113 women, from 7 centers, ages 23-95, 168 Stage I, 117 Stage II, 241 oral and 44 oropharyngeal tumors; 74% of patients were treated by surgery alone, the rest received adjuvant radiotherapy. The mean followup interval was 32 months. Disease-progression and disease-specific mortality rates among Stage I and Stage II patients were 19%, 10%, 20%, and 8%, respectively. Regression analysis show that the risk categories significantly associate with decreased time to DP (p = 0.0104, HR 1.95, 95% CI 1.17, 3.24) and OS, (p = 0.0156, HR 1.70, 95% CI 1.11, 2.61) when adjusted for confounders.
Conclusions: We demonstrate that the Risk Model has added prognostic value for low-stage patients with respect to DP and OS. These data justify the need for future randomized clinical trials offering adjuvant radiotherapy for the sole indication of high-risk status.
Category: Head & Neck
Tuesday, March 1, 2011 11:45 AM
Platform Session: Section G, Tuesday Morning