Importance Brigham and Women’s tumor classification (BWH) better predicts poor outcomes than American Joint Committee on Cancer (AJCC) 7th edition (AJCC 7). AJCC 8th edition (AJCC 8) has not been evaluated.

Objectives To compare BWH and AJCC 8 tumor classifications for head and neck cutaneous squamous cell carcinoma (HNCSCC).

Design, Setting, and Participants A total of 459 patients with 680 HNCSCCs in this cohort study were staged via BWH and AJCC 8 classifications and poor outcomes (ie, local recurrence [LR], nodal metastasis [NM], disease specific death [DSD], and overall survival [OS]) were compared. The study was carried out at a single academic tertiary care center in Boston, Massachusetts.

Main Outcomes and Measures Distinctiveness (outcome differences between tumor class), homogeneity (outcome similarity within tumor class), monotonicity (outcome worsening with increasing tumor class), and C statistic.

Results A total of 680 HNCSCCs in 459 patients were included in this study, of which 313 (68%) were men with the mean (SD) age of 70.2 (12.7) years. The AJCC 8 (T3/T4) and BWH (T2b/T3) high tumor classes accounted for 121 (18%) vs 63 (9%), 17 (71%) vs 16 (70%), and 11 (85%) vs 12 (92%) of total cases, metastases, and deaths, respectively. The AJCC 8 T2 and T3 comprised 23% of cases and had statistically indistinguishable outcomes. The BWH had higher specificity (93%) and positive predictive value (30%) for identifying cases at risk for metastasis or death. C statistics showed BWH to be superior in predicting NM and DSD (P = .01 and P = .005, respectively), but there was no difference for LR and OS.

Conclusions and Relevance Lack of distinction between AJCC T2 and T3 resulted in a 23% subset of HNCSCCs with significant risk of metastasis and death—too large of a group for routine nodal staging or consideration of adjuvant therapy. The BWH identifies the same number of poor outcomes in a 9% subset of HNCSCCs, thus minimizing inappropriate upstaging of low-risk disease.

重要性Brigham and Women 肿瘤分类 (BWH) 比美国癌症联合委员会 (AJCC) 第 7 版 (AJCC 7) 更好地预测不良结果。 AJCC 第 8 版 (AJCC 8) 尚未经过评估。

目的比较头颈皮肤鳞状细胞癌 (HNCSCC) 的 BWH 和 AJCC 8 肿瘤分类。

设计、背景和参与者本队列研究共有 459 名患有 680 个 HNCSCC 的患者通过 BWH 和 AJCC 8 分类进行分期，结果较差（即局部复发 [LR]、淋巴结转移 [NM]、疾病特异性死亡 [DSD]） ，和总生存期[OS]）进行了比较。该研究是在马萨诸塞州波士顿的一个学术三级护理中心进行的。

主要结果和测量独特性（肿瘤类别之间的结果差异）、同质性（肿瘤类别内的结果相似性）、单调性（结果随着肿瘤类别的增加而恶化）和 C 统计量。

结果本研究共纳入 459 例患者的 680 例 HNCSCC，其中 313 例 (68%) 为男性，平均 (SD) 年龄为 70.2 (12.7) 岁。 AJCC 8 (T3/T4) 和 BWH (T2b/T3) 高肿瘤类别占 121 (18%) vs 63 (9%)、17 (71%) vs 16 (70%) 和 11 (85%)总病例数、转移数和死亡数分别为 12 例 (92%)。 AJCC 8 T2 和 T3 占病例的 23%，并且具有统计学上无法区分的结果。 BWH 对于识别有转移或死亡风险的病例具有较高的特异性 (93%) 和阳性预测值 (30%)。 C 统计数据显示 BWH 在预测 NM 和 DSD 方面优于（分别为 P = .01 和 P = .005），但 LR 和 OS 没有差异。

结论和相关性AJCC T2 和 T3 之间缺乏区别导致 23% 的 HNCSCC 子集具有显着的转移和死亡风险，对于常规淋巴结分期或考虑辅助治疗而言，该组太大。 BWH 在 9% 的 HNCSCC 子集中发现了相同数量的不良结果，从而最大限度地减少低风险疾病的不适当升级。