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Grade as a prognostic factor in oral squamous cell carcinoma: a population-based analysis of the data.
Laryngoscope. 2014 Mar; 124(3):688-94.L

Abstract

OBJECTIVES/HYPOTHESIS

Historically, histologic grade has not been considered a useful prognostic factor in head and neck squamous cell carcinoma (SCC). However, in other solid tumors, grade is known to affect prognosis. We test the hypothesis that histologic grade is an independent predictor of prognosis in oral cavity SCC.

STUDY DESIGN

Population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute.

METHODS

Fifteen year cause-specific survival. Multivariate analysis was performed on a subset of patients diagnosed between 2004 and 2008.

RESULTS

Among patients 20 to 65 years of age with American Joint Committee on Cancer (AJCC) stage I or II cancer, the adjusted risk of death is 2.7 times greater (95% CI 1.72-4.11) if the tumor is poorly differentiated or undifferentiated than it is if the tumor is well differentiated. Among patients 66 to 94 years of age, the risk of death is 3.0 (95% CI 2.02-4.54) times greater. For those over age 65, moderately differentiated tumors also confer an estimated 42% increased risk of death, but this estimate is only borderline significant (P = 0.05).

CONCLUSIONS

There is a strong association between histologic grade and survival in patients with AJCC stage I or II oral cavity SCC. High histologic grade in early stage oral cavity cancer is associated with poorer survival and carries independent prognostic value in addition to tumor size, node status, and presence of distant metastasis (TNM) stage. Thus, histologic grade should be considered clinically when making treatment decisions, and multivariable models of survival should include grade as a covariate to improve prognostic accuracy.

Authors+Show Affiliations

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center, Lebanon.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23945976

Citation

Thomas, Brian, et al. "Grade as a Prognostic Factor in Oral Squamous Cell Carcinoma: a Population-based Analysis of the Data." The Laryngoscope, vol. 124, no. 3, 2014, pp. 688-94.
Thomas B, Stedman M, Davies L. Grade as a prognostic factor in oral squamous cell carcinoma: a population-based analysis of the data. Laryngoscope. 2014;124(3):688-94.
Thomas, B., Stedman, M., & Davies, L. (2014). Grade as a prognostic factor in oral squamous cell carcinoma: a population-based analysis of the data. The Laryngoscope, 124(3), 688-94. https://doi.org/10.1002/lary.24357
Thomas B, Stedman M, Davies L. Grade as a Prognostic Factor in Oral Squamous Cell Carcinoma: a Population-based Analysis of the Data. Laryngoscope. 2014;124(3):688-94. PubMed PMID: 23945976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Grade as a prognostic factor in oral squamous cell carcinoma: a population-based analysis of the data. AU - Thomas,Brian, AU - Stedman,Margaret, AU - Davies,Louise, Y1 - 2013/10/04/ PY - 2013/05/30/revised PY - 2013/07/22/accepted PY - 2013/8/16/entrez PY - 2013/8/16/pubmed PY - 2014/4/29/medline KW - Oral cavity KW - SEER KW - and end results database KW - grade KW - pathology KW - prognosis KW - squamous cell carcinoma KW - survival KW - survival epidemiology SP - 688 EP - 94 JF - The Laryngoscope JO - Laryngoscope VL - 124 IS - 3 N2 - OBJECTIVES/HYPOTHESIS: Historically, histologic grade has not been considered a useful prognostic factor in head and neck squamous cell carcinoma (SCC). However, in other solid tumors, grade is known to affect prognosis. We test the hypothesis that histologic grade is an independent predictor of prognosis in oral cavity SCC. STUDY DESIGN: Population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. METHODS: Fifteen year cause-specific survival. Multivariate analysis was performed on a subset of patients diagnosed between 2004 and 2008. RESULTS: Among patients 20 to 65 years of age with American Joint Committee on Cancer (AJCC) stage I or II cancer, the adjusted risk of death is 2.7 times greater (95% CI 1.72-4.11) if the tumor is poorly differentiated or undifferentiated than it is if the tumor is well differentiated. Among patients 66 to 94 years of age, the risk of death is 3.0 (95% CI 2.02-4.54) times greater. For those over age 65, moderately differentiated tumors also confer an estimated 42% increased risk of death, but this estimate is only borderline significant (P = 0.05). CONCLUSIONS: There is a strong association between histologic grade and survival in patients with AJCC stage I or II oral cavity SCC. High histologic grade in early stage oral cavity cancer is associated with poorer survival and carries independent prognostic value in addition to tumor size, node status, and presence of distant metastasis (TNM) stage. Thus, histologic grade should be considered clinically when making treatment decisions, and multivariable models of survival should include grade as a covariate to improve prognostic accuracy. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/23945976/Grade_as_a_prognostic_factor_in_oral_squamous_cell_carcinoma:_a_population_based_analysis_of_the_data_ L2 - https://doi.org/10.1002/lary.24357 DB - PRIME DP - Unbound Medicine ER -