Comparison of the seventh and eighth editions American Joint Committee Cancer classification system in oral cavity squamous cell cancers

Abstract

The aim of our study was to evaluate the predictive ability of the American Joint Committee Cancer (AJCC) eighth edition (AJCC8) staging system for oral cavity cancers and validate these changes rendering the hypothesis of improving prognostication. We conducted a retrospective study including all oral cavity squamous cell carcinoma patients visiting our tertiary center from 2012 to 2015, staged as per the AJCC seventh edition (AJCC7) and AJCC8 systems. Stage-specific diseasefree survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Concordance index (CI) and Akaike information criterion (AIC) were used to calculate the predictive accuracy of the both systems. The study sample consisted of 863 subjects followed up for a median of 24 months. Buccal mucosa complex (BMC) was the most common site (n = 496). We observed a 25.8% (n = 222) overall upstaging in the eighth edition, significantly seen in early tongue cancers (TCs) (Stage I) and advanced BMC cancers (Stage III). An increase in CI and reduction in AIC scores were indicative of a superior predictive accuracy for the eighth edition in assessing DFS (confidence interval [CI*] = 0.650-0.654; AIC = 3,022-3,014) and OS (CI* = 0.643-0.648; AIC = 2089-2086) across all stages. The accuracy was higher for TCs as compared to BMC. Although not statistically significant, we observed an increase in soft risk factors at higher stages in the eighth edition as compared to its predecessor. We concluded that the AJCC8 has a higher predictive accuracy than the AJCC7 edition, making it a reliable prognosticative tool.

The 8th TNM classification for oral squamous cell carcinoma: What is gained, what is lost, and what is missing

“…More specifically, 20 patients (9.8%) would have been shifted from stage I-II "early disease" to stage III-IV "advanced disease", while only 3 (1.5%) would have been downstaged. All these modifications in T and N classification and staging are consistent with other published reports [17,18]. Such an important stage migration, and in particular the shift from early to advanced disease, convey relevant implications in treatment planning.…”

“…Coherently, T4a tumors are associated with the poorest results when focusing on loco-regional control. These data are in accordance with literature, as several reports from all over the world demonstrated higher predictive accuracy of the 8th TNM edition [17][18][19][20][21][22][23][24].…”

Outcome Analysis of Advanced Oral Cancers Requiring Large Composite Fibular Osteocutaneous Flap Reconstruction

“…The 5-year overall survival for the cohort was surprisingly 52.1%, and the disease-free survival was 48.6%. Multiple studies have shown the 5-year overall survival of oral squamous cell carcinomas to be ranging from 79.9% to 60% for the entire spectrum of TNM stages 17–21 . An in-house study showed an overall survival of 68.4% for resectable advanced (stages III and IV) cases 6 .…”

Expression of caveolin-2 in patients with oral cancer and correlations with clinicopathological parameters

“…There were 121 males and 52 females aged 40-67 years old and (52.8 ± 13.3) years old on average. The tumor-node-metastasis (TNM) stage of the patients was determined according to the 8th edition of TNM staging system for lip and oral cavity tumors jointly published by the American Joint Committee on Cancer and Union for International Cancer Control (SINGHAVI et al, 2020), including 33 cases of stage I, 41 cases of stage II, 47 cases of stage III and 52 cases of stage IV. Moreover, oral cancer was classified into 3 grades based on the pathological differentiation degree (KUKREJA et al, 2020), i.e.…”