Validation of the American Joint Committee on Cancer Staging in Squamous Cell Carcinoma of the Vermilion Lip

Yung, Amanda; Que, Michael S; Lo, Serigne; Aggarwal, Shagun; Hong, Angela; Tin, Mo Mo; Clark, Jonathan; Gupta, Ruta; Ch’ng, Sydney

doi:10.1245/s10434-020-09431-4

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…Of these 129 studies, 114 studies assessed risk factors, with a total of 137 449 patients and 126 553 tumors. Of these, 87 studies with 122 484 tumors were included in the random effects analysis risk ratio, and 62 studies with 116 958 tumors were included in analysis of incidence data. Treatment modality was assessed by 28 studies…”

Section: Resultsmentioning

confidence: 99%

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Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

et al. 2023

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ImportancePrimary cutaneous squamous cell carcinoma is usually curable; however, a subset of patients develops poor outcomes, including local recurrence, nodal metastasis, distant metastasis, and disease-specific death.ObjectivesTo evaluate all evidence-based reports of patient risk factors and tumor characteristics associated with poor outcomes in primary cutaneous squamous cell carcinoma and to identify treatment modalities that minimize poor outcomes.Data SourcesPubMed, Embase, and SCOPUS databases were searched for studies of the topic in humans, published in the English language, from database inception through February 8, 2022.Study SelectionTwo authors independently screened the identified articles and included those that were original research with a sample size of 10 patients or more and that assessed risk factors and/or treatment modalities associated with poor outcomes among patients with primary cutaneous squamous cell carcinoma.Data Extraction and SynthesisData extraction was performed by a single author, per international guidelines. The search terms, study objectives, and protocol methods were defined before study initiation. A total of 310 studies were included for full-text assessment. Owing to heterogeneity of the included studies, a random-effects model was used. Data analyses were performed from May 25 to September 15, 2022.Main Outcomes and MeasuresFor studies of risk factors, risk ratios and incidence proportions; and for treatment studies, incidence proportions.ResultsIn all, 129 studies and a total of 137 449 patients with primary cutaneous squamous cell carcinoma and 126 553 tumors were included in the meta-analysis. Several patient risk factors and tumor characteristics were associated with local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death were identified. Among all factors reported by more than 1 study, the highest risks for local recurrence and disease-specific death were associated with tumor invasion beyond subcutaneous fat (risk ratio, 9.1 [95% CI, 2.8-29.2] and 10.4 [95% CI, 3.0- 36.3], respectively), and the highest risk of any metastasis was associated with perineural invasion (risk ratio, 5.0; 95% CI, 2.3-11.1). Patients who received Mohs micrographic surgery had the lowest incidence of nearly all poor outcomes; however, in some results, the 95% CIs overlapped with those of other treatment modalities.Conclusions and RelevanceThis meta-analysis identified the prognostic value of several risk factors and the effectiveness of the available treatment modalities. These findings carry important implications for the prognostication, workup, treatment, and follow-up of patients with primary cutaneous squamous cell carcinoma.Trial RegistrationPROSPERO Identifier: CRD42022311250

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Section: Resultsmentioning

confidence: 99%

“…After inclusion criteria were applied, the full text of 310 articles were assessed. Of these, 129 studies were included in final analysis (Figure 1). Study characteristics, including risk of bias, are described in eTable 1 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

et al. 2023

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“…clean categorization and staging by virtue of their unique structure and site. 2 The past seventh edition of the AJCC included squamous cell cancers of the vermilion lip (vlSCC) with cancers of the oral cavity (oSCC), but the eight edition recognizes that the exterior location of the vermilion relative to the oral cavity implies exposure to ultraviolet (UV) light, evidenced by UV damage mutation signatures in vlSCC. 3 As a transition zone between cutaneous hair bearing skin and the oral cavity, vlSCC is thought to have a clinical course between the generally more aggressive tobacco and alcohol abuse associated oSCC, and cutaneous squamous cell cancers (cSCC) with a more favorable prognosis.…”

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confidence: 99%

“…In their retrospective analysis, Yung et al suggest that this may indeed be the case with AJCC8 staging for vlSCC. 2 They study 297 patients who presented with vlSCC over a 15-year period in the Sydney Local Health District and found that the changes in the pT AJCC classification resulted in 24% of patients being upstaged with no patients being downstaged, and with respect to overall staging, 21% of patients were upstaged while none were downstaged. Overall, this resulted in a significant number of patients being upstaged to stage III disease.…”

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Editorial: Cancer Staging in Squamous Cell Carcinoma of the Vermilion Lip

Sumer

2021

Ann Surg Oncol

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The eighth edition of the AJCC Cancer Staging Manual implemented several major changes to improve and refine the prognostic value of head and neck cancer staging. With each iteration the AJCC Cancer Staging Manual becomes more detailed, and this latest edition, adopted in 2018, reflects our progressively greater understanding of the biology of head and neck cancer. The goals of staging are to provide a reliable standard of classifying tumors based on tumor-node-metastasis (TNM) status and location and help better direct therapy to improve patient outcomes. The classification system also provides a mechanism for standardizing communication about prognosis and treatment outcomes across different institutions, regions, and countries. One change in the eighth edition, for example, is the introduction of a new staging system for high-risk human papillomavirus (HPV)-associated oropharyngeal cancers, recognizing the fact that these tumors have a biology and prognosis distinct from non-HPV associated cancers in the same anatomic location. Although early versions of TNM staging were based on anatomic involvement, we can anticipate that future revisions to the TNM staging system will incorporate our greater understanding of the molecular underpinnings of head and neck cancer. 1 Despite this greater, more refined understanding of carcinogenesis, in this issue of the Annals of Surgical Oncology, Yung et al. show that the complex anatomy of the head and neck harbors locations with cancers that defy

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Cheek and Perioral Cancer

Klaassen¹,

Burton²

2022

Atlas of Extreme Facial Cancer

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Validation of the American Joint Committee on Cancer Staging in Squamous Cell Carcinoma of the Vermilion Lip

Cited by 4 publications

References 24 publications

Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

Editorial: Cancer Staging in Squamous Cell Carcinoma of the Vermilion Lip

Cheek and Perioral Cancer

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