{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T20:14:02Z","timestamp":1762460042386,"version":"3.40.5"},"reference-count":32,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T00:00:00Z","timestamp":1632441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82002868"],"award-info":[{"award-number":["82002868"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A universally acknowledged cancer staging system considering all aspects of the T\u2010, N\u2010, and M\u2010classifications for middle ear squamous cell carcinoma (MESCC) remains absent, limiting the clinical management of MESCC patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>A total of 214 MESCC patients were extracted from the SEER (the Surveillance, Epidemiology, and End Results) database between 1973 and 2016. The relationships between patient\u2019s characteristics and prognoses were analyzed by Kaplan\u2013Meier and Cox proportional hazards regression models. Novel staging schemes for MESCC were designed by adjusted hazard ratio (AHR) modeling method according to the combinations of Stell\u2019s T\u2010classification and the eighth AJCC N\u2010 and M\u2010classifications, of which performances were evaluated based on five criteria: hazard consistency, hazard discrimination, explained variation, likelihood difference, and balance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>T\u2010classification was the most significant prognostic factor for MESCC patients in multivariable analysis (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.021). The N\u2010 and M\u2010classifications also had obvious prognostic effect but were not statistically significant by multivariate analysis due to the limited metastasis events. Three novel staging schemes (AHR\u2010\u2160\u2013\u2162 models, different combination of T\u2010 and N\u2010classifications) and ST (solely derived from Stell\u2019s T\u2010classification) were developed, among which the AHR\u2010\u2160 staging scheme performed best.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tumor extension, quantified by Stell\u2019s T\u2010classification, is the most significant prognostic factor for MESCC patients. However, our AHR\u2010\u2160 staging scheme, a comprehensive staging scheme that integrating T\u2010, N\u2010, and M\u2010classifications, might be an optimal option for clinical practitioners to predict MESCC patients\u2019 prognosis and make proper clinical decisions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.4306","type":"journal-article","created":{"date-parts":[[2021,9,25]],"date-time":"2021-09-25T01:11:19Z","timestamp":1632532279000},"page":"7958-7967","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating the prognostic contributions of TNM classifications and building novel staging schemes for middle ear squamous cell carcinoma"],"prefix":"10.1002","volume":"10","author":[{"given":"Ke","family":"Qiu","sequence":"first","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendu","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianqing","family":"Qiu","sequence":"additional","affiliation":[{"name":"West China Biomedical Big Data Center West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junhong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danni","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yufang","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yijun","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minzi","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiurui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaosong","family":"Mu","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology Langzhong People\u2019s Hospital Langzhong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"West China Biomedical Big Data Center West China Hospital Sichuan University Chengdu China"},{"name":"Medical Big Data Center Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Princess Margaret Cancer Centre and Dalla Lana School of Public Health Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjun","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"},{"name":"West China Biomedical Big Data Center West China Hospital Sichuan University Chengdu China"},{"name":"Medical Big Data Center Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1874-908X","authenticated-orcid":false,"given":"Yu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Oto\u2010Rhino\u2010Laryngology West China Hospital Sichuan University Chengdu China"},{"name":"West China Biomedical Big Data Center West China Hospital Sichuan University Chengdu China"},{"name":"Medical Big Data Center Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,9,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23660"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20202"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(05)70208-4"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.01.052"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e318281e0a9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-013-2728-1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.102297"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-6665(05)70374-1"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2018-0415-SA"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100097796"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100115956"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949009900909"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2016.165"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(98)00531-8"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(00)00220-6"},{"key":"e_1_2_9_17_1","first-page":"1014","article-title":"Refining evaluation methodology on TNM stage system: assessment on HPV\u2010related oropharyngeal cancer","volume":"2","author":"Xu W","year":"2015","journal-title":"Austin Biom Biostat"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00560-4"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-010-1693-9"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.1087"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820980708"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000001491"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-554"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1159\/000334243"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489.2015.1094825"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-002-0051-x"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e318210b90f"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016480802642096"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28653"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000001152"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-018-1314-3"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24133"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2019.02.004"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.4306","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.4306","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.4306","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T16:57:31Z","timestamp":1693241851000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.4306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,24]]},"references-count":32,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1002\/cam4.4306"],"URL":"https:\/\/doi.org\/10.1002\/cam4.4306","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"type":"print","value":"2045-7634"},{"type":"electronic","value":"2045-7634"}],"subject":[],"published":{"date-parts":[[2021,9,24]]},"assertion":[{"value":"2021-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}