The Laryngoscope C 2013 The American Laryngological, V
Rhinological and Otological Society, Inc.
Comparison of the AJCC N Staging System in Mucosal and Cutaneous Squamous Head and Neck Cancer Markus Brunner, MD; Beverly C. Ng, MBBS (Hons); Michael J. Veness, MMed, MD, FRANZCR; Jonathan R. Clark, MBBS (Hons), MBiostat, FRACS Objectives/Hypothesis: The American Joint Committee on Cancer (AJCC) substantially changed the staging of cutaneous squamous cell carcinoma (cSCC) in the seventh edition of its staging manual. Given that oral mucosal squamous cell carcinoma (mSCC) and cSCC behave differently and affect different patient populations, the aim of this study was to provide a side-by-side comparison and to evaluate the current nodal (N) grouping for cSCC alongside oral mSCC to determine whether the same system is justified Study Design: Retrospective analysis of prospectively collected data. Methods: Multivariable analysis of 672 patients with metastatic cSCC and of 225 patients with metastatic mSCC from two prospective cancer-center databases. Results: While, as expected, the N grouping functioned well in mSCC in terms of distribution and stratification of patients, it performed much less favorably in cSCC. In contrast to mSCC, the different N groups demonstrate much less prognostic importance in cSCC. Conclusion: Although the introduction of a unified N system for mSCC and cSCC has definite advantages, it does not translate into optimal distribution and stratification for metastatic cSCC. Key Words: SCC, staging, TNM, nodal. Level of Evidence: 4. Laryngoscope, 124:1598–1602, 2014
INTRODUCTION Nonmelanoma skin cancer (NMSC) is the most common malignancy worldwide. Cutaneous squamous cell carcinoma (cSCC) account for 20% of all NMSC.1 The worldwide incidence of cSCC has increased over the past decade, contributing to significant health burden in countries such as Australia with Anglo-Celtic populations who are exposed to high levels of sunlight.2 Other risk factors include increasing age, male gender, and immunodeficiency (particularly solid organ transplant recipients).3–5 cSCC most commonly occur on the head and neck, with the majority exhibiting low risk features translating into a low incidence of regional lymph node metastases (
Rhinological and Otological Society, Inc.
Comparison of the AJCC N Staging System in Mucosal and Cutaneous Squamous Head and Neck Cancer Markus Brunner, MD; Beverly C. Ng, MBBS (Hons); Michael J. Veness, MMed, MD, FRANZCR; Jonathan R. Clark, MBBS (Hons), MBiostat, FRACS Objectives/Hypothesis: The American Joint Committee on Cancer (AJCC) substantially changed the staging of cutaneous squamous cell carcinoma (cSCC) in the seventh edition of its staging manual. Given that oral mucosal squamous cell carcinoma (mSCC) and cSCC behave differently and affect different patient populations, the aim of this study was to provide a side-by-side comparison and to evaluate the current nodal (N) grouping for cSCC alongside oral mSCC to determine whether the same system is justified Study Design: Retrospective analysis of prospectively collected data. Methods: Multivariable analysis of 672 patients with metastatic cSCC and of 225 patients with metastatic mSCC from two prospective cancer-center databases. Results: While, as expected, the N grouping functioned well in mSCC in terms of distribution and stratification of patients, it performed much less favorably in cSCC. In contrast to mSCC, the different N groups demonstrate much less prognostic importance in cSCC. Conclusion: Although the introduction of a unified N system for mSCC and cSCC has definite advantages, it does not translate into optimal distribution and stratification for metastatic cSCC. Key Words: SCC, staging, TNM, nodal. Level of Evidence: 4. Laryngoscope, 124:1598–1602, 2014
INTRODUCTION Nonmelanoma skin cancer (NMSC) is the most common malignancy worldwide. Cutaneous squamous cell carcinoma (cSCC) account for 20% of all NMSC.1 The worldwide incidence of cSCC has increased over the past decade, contributing to significant health burden in countries such as Australia with Anglo-Celtic populations who are exposed to high levels of sunlight.2 Other risk factors include increasing age, male gender, and immunodeficiency (particularly solid organ transplant recipients).3–5 cSCC most commonly occur on the head and neck, with the majority exhibiting low risk features translating into a low incidence of regional lymph node metastases (
