Clinical and Prognostic Significance of the Eighth Edition Oral Cancer Staging System

Ghantous, Yasmin; Nashef, Aysar; Sidransky, David; Abdelraziq, Murad; Alkeesh, Kutaiba; Araidy, Shareef; Koch, Wayne M.; Brait, Mariana; El-Naaj, Imad Abu

doi:10.3390/cancers14194632

Cited by 10 publications

(12 citation statements)

References 28 publications

(45 reference statements)

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“…We speculate that the more extensive, more representative tissue sampling afforded by surgical excision increases the likelihood of detecting foci of microinvasive disease, which may have otherwise been missed with incision. Lower oncologic staging is the most powerful prognosticator in oral cavity cancer, and significantly improved survival outcomes associated with stage I and II disease compared to stage III and IV are well known and supported by our results 1,53–55 . Cox univariate analyses showed significant associations between management of OED by surgical excision of the preceding OED and overall survival, which we speculate is secondary to the significantly lower oncologic staging within the excisional group.…”

Section: Discussionsupporting

confidence: 83%

“…Lower oncologic staging is the most powerful prognosticator in oral cavity cancer, and significantly improved survival outcomes associated with stage I and II disease compared to stage III and IV are well known and supported by our results. 1,[53][54][55] Cox univariate analyses showed significant associations between management of OED by surgical excision of the preceding OED and overall survival, which we speculate is secondary to the significantly lower oncologic staging within the excisional group. OED with a homogenous clinical appearance was also associated with improved overall survival, which we speculate is explained by the increased likelihood that homogenous OED will be managed by surgical excision supported by logistic regression.…”

Section: Discussionmentioning

confidence: 82%

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Clinical outcomes of oral epithelial dysplasia managed by observation versus excision

Bernard,

Zhang,

Klieb

et al. 2023

Head & Neck

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ImportanceOral potentially malignant disorders, including oral epithelial dysplasia (OED), are a group of conditions with an increased risk of progression to oral cancer. Clinical management of OED is challenging and usually involves monitoring with repeated incisional biopsies or complete surgical excision.ObjectiveTo determine if complete surgical excision of OED impacts malignant transformation or improves survival outcomes in lesions that progress to malignancy.DesignA retrospective review of all patients diagnosed with OED between 2009 and 2016 was completed, and patients were followed until January 2022 for disease course and outcomes.ResultsHundred and fifty‐five cases of OED met the inclusion criteria. Among the 61 lesions managed by observation, 15 progressed to cancer. Among the 94 lesions managed by surgical excision, 27 progressed to cancer. The overall malignant transformation rate was 27%, with an annual rate of 6.4%. Surgical excision with or without histologically negative margins did not decrease malignant transformation but was associated with lower oncologic staging at the time of diagnosis and improved survival.Conclusions and relevanceSurgical excision of OED with or without negative margins did not reduce the rate of transformation to oral cancer but resulted in lower oncologic staging at diagnosis, leading to improved patient outcomes. Our results support the implementation of more extensive tissue sampling to improve cancer diagnosis and patient outcomes.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 82%

Clinical outcomes of oral epithelial dysplasia managed by observation versus excision

Bernard,

Zhang,

Klieb

et al. 2023

Head & Neck

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“…Despite this limitation, we believe that the follow-up period of the patients was longer than that in previous studies. 19,20 Therefore, the cohort was classified according to the 7th edition, which does not consider pathological findings, such as the DOI of the primary tumor or tumor ECS in cervical lymph node metastasis. Although previous studies failed to find a direct relationship between the DOI and prognosis, they found a strong correlation between the DOI and the risk of nodal metastasis, especially in early stage tumors.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study

DIAS,

HILDEBRAND,

CARVALHO

et al. 2023

Braz. oral res.

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Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.

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“…This retrospective study included 111 OSCC patients’ data retrieved from patient records in the Dental Information Archival Software (DIAS) used in Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, between March 2020 and September 2023 with a purposive sampling technique and ethical approval (IHEC/SDC/UG-1871/23/OMR/332) obtained from the same institute to conduct the study and extract the data. Clinicopathological information of each case, such as age (categorized into seven groups: 21-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years, 71-80 years, and 81-90 years), gender, habit duration, anatomical region (buccal mucosa, tongue, maxillary alveolus, mandibular alveolus, combination of maxillary and mandibular alveolus, and floor of the mouth), TNM (tumor, nodal, and metastasis) staging 8th edition, 2017 at the time of diagnosis [ 12 ], perineural invasion, lymphovascular invasion, and overall oral health were assessed with a modified Oral Health Impact Profile (OHIP) questionnaire comprising of seven questions on difficulty in swallowing, taste, mastication, speech, and pain or discomfort in the oral cavity of the patient that were categorized under five domains [ 13 ]. The questions were asked by the physician to the patient postoperatively, and the scores were recorded based on the responses obtained from the patient, which ranged between 0 and 10, to evaluate the oral health-related quality of life.…”

Section: Methodsmentioning

confidence: 99%

A Comprehensive Retrospective Institutional Study for Decoding Oral Squamous Cell Carcinoma

Reichal,

Prethipa

2024

Cureus

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Background Oral cancer is found to be the thirteenth most common cancer as stated by the WHO (World Health Organization 2023). Oral squamous cell carcinoma (OSCC) is associated with deleterious oral habits such as smoking, chewing tobacco and betel quid, alcohol consumption, low socioeconomic status, sharp teeth, and various causative factors. Materials and methods A three-year retrospective analysis (March 2020-September 2023) was carried out with the available patient records in the Dental Information Archival Software (DIAS) used in a private dental college in Chennai. The demographic data such as age, gender, and habit duration and clinicopathological data such as the anatomical site; tumor, node, and metastasis (TNM) staging; perineural invasion (PNI); lymphovascular invasion (LVI); and oral health-related quality of life were retrieved. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results Males (78.35%) more commonly reported OSCC than females (21.62%), and the majority of them were in the age category of fifth to seventh decades of life. The most affected region was the buccal mucosa with 33.3%, followed by the lower alveolus with 30.63%. The duration of harmful habits varied from one year to more than 40 years, and the majority of the patients had T4a staging (40.54%), followed by T2 staging (29.73%) with a habit duration of more than five years. Approximately 22.52% and 0.9% had PNI and LVI, respectively. The correlation between the two variables was evaluated using the Pearson correlation test and was found to be statistically significant (p < 0.05), i.e., habit to gender and staging with gender were p = 0.027 and p = 0.028, respectively. Conclusion The majority of cases reported were found to be at T4a tumor staging with a habitual duration of more than five years, and more than half of the study population had severe compromise in their quality of life. The presence of perineural invasion and lymphovascular invasion has an impact on nodal metastasis, treatment choices, recurrence, and oral health-related quality of life. To address this challenge, oral health programs can implement comprehensive antitobacco counseling strategies, oral cancer public awareness programs to tackle the rising incidence of OSCC, and early oral precancer screening measures to enhance the prevention and overall quality of life of individuals with oral cancer.

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Clinical and Prognostic Significance of the Eighth Edition Oral Cancer Staging System

Cited by 10 publications

References 28 publications

Clinical outcomes of oral epithelial dysplasia managed by observation versus excision

Clinical outcomes of oral epithelial dysplasia managed by observation versus excision

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study

A Comprehensive Retrospective Institutional Study for Decoding Oral Squamous Cell Carcinoma

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