Individualized Risk Assessment of Distant Metastases in Oral Cavity Carcinoma: A Validated Predictive-Score Model
Menée à partir de données portant sur 2 749 patients atteints d'un carcinome de la cavité buccale traité par chirurgie curative en combinaison ou non avec une radiothérapie ou une chimioradiothérapie postopératoire, cette étude évalue la performance d'un système de score, basé sur le stade tumoral, le grade histologique ainsi que la présence de métastases ganglionnaires et d'un envahissement lymphovasculaire, pour identifier les patientes présentant un risque élevé de métastases distantes
Background : We aimed to develop and validate a risk-scoring system for distant metastases (DM) in oral cavity carcinoma (OCC).
Methods : OCC patients treated at 4 tertiary cancer institutions with curative surgery +/- postoperative radiation/chemo-radiation (PORT/PO-CRT) were randomly divided into discovery and validation cohorts (3:2 ratio). Cases were staged based on TNM 8th edition. Predictors of DM on multivariable analysis in the discovery cohort were used to develop a risk-score model and classify patients into risk groups. The utility of the risk classification was evaluated in the validation cohort.
Results : Overall 2749 patients were analyzed. Predictors (risk score coefficient) of DM in the discovery cohort were: pT3-4 (0.4), pN + (N1: 0.8; N2: 1.0; N3: 1.5), histologic grade 3 (G3, 0.7) and lymphovascular invasion (LVI, 0.4). The DM risk groups were defined by the sum of risk score coefficients: high (>1.7), intermediate (0.7-1.7), and standard risk (<0.7). The 5-year DM rate (high/intermediate/standard risk groups) was 30%/15%/4% in the discovery cohort (C-index = 0.79) and 35%/16%/5%, respectively in the validation cohort (C-index = 0.77) (both p < 0.001). In the whole cohort, this predictive model showed excellent discriminative ability in predicting DM without locoregional failure (29%/11%/1%), later (>2 year) DM (11%/4%/2%), DM in patients treated with surgery (20%/12%/5%), PORT (34%/17%/4%), and PO-CRT (39%/18%/7%) (all p < 0.001). The 5-year overall survival in the overall cohort was 25%/51%/67% (p < 0.001).
Conclusions : A predictive-score model for DM including pT3-4, pN1/2/3, grade 3 and LVI identified patients at higher risk for DM who may be evaluated for individualized risk-adaptive treatment escalation and/or surveillance strategies.
Journal of the National Cancer Institute , résumé, 2022