Cutaneous head/neck cancer: Brigham and Women’s classification outperforms AJCC 8

  • Ruiz ES & al.
  • JAMA Dermatol
  • 10 Apr 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Compared with the American Joint Committee on Cancer eighth edition (AJCC 8), the Brigham and Women’s Hospital Tumor Classification System (BWH) has higher specificity and positive predictive value (PPV) for risk of metastasis or death in patients with cutaneous head and neck squamous cell carcinoma (cHNSCC).

Why this matters

  • Identifying the best prognostic system is important for the subset of tumors with high risk for poor outcomes.

Key results

  • BWH and AJCC 8 had comparable monotonicity (outcome worsening with increasing tumor class: P=.46 for local recurrence [LR]; P=.92 for nodal metastasis [NM]; P=.54 for disease-specific death [DSD]; P=.67 for overall events) and homogeneity (outcome differences between tumor class: P=.46 for LR; P=.92 for NM; P=.53 for DSD; P=.67 for overall events).
  • BWH was superior to AJCC 8 for predicting NM (C statistic 0.91 vs 0.84; P=.01) and DSD (C statistic 0.97 vs 0.91; P=.005).
  • The BWH system had higher specificity (0.93 vs 0.85; P<.001 and ppv vs statistics performed compared with ajcc for nm risk.>

Study design

  • 459 patients with 680 cHNSCCs were included.
  • Funding: None disclosed.

Limitations

  • Single-center cohort study.

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