Depth of invasion (DOI) as a predictor of cervical nodal metastasis and local recurrence in early stage squamous cell carcinoma of oral tongue (ESSCOT)

Abstract

BackgroundThe new AJCC staging system (8th edition) incorporates depth of invasion to stage oral cancers. It is a recognized predictor for neck nodal metastasis and local recurrence, the associated risk is not well defined. The aim of this study was to explore the risk of occult neck nodal metastasis and local recurrence in relation to depth in early stage squamous cell carcinoma of oral tongue.MethodsWe have evaluated records of 179 patients with early tongue cancer treated in our unit from 2006–2015 with a mean age of 57.92 ± 11.93 years. Treatment modalities used were surgery (26%), surgery followed by radiotherapy (64%) and chemo-radiation (10%). Neck dissection was ipsilateral in 94% and bilateral in 6% of the patients. Patients were grouped according to the AJCC cut off points in 8th edition for depth; group A: 1–5 mm (35%), group B: 6–10 mm (47%) and group C: > 10 mm (18%).ResultsRisk of local recurrence and nodal metastasis for Group A was 15% (10/63) and 23% (15/63), group B 20% (17/84) and 34% (29/84), and group C 40% (13/32) and 53% (17/32).ConclusionsDepth more than 10 mm is associated with significantly increased risk of recurrence and nodal metastasis. Elective neck dissection should be a consideration for tumors having depth less than 5mm.

Tumor depth of invasion and prognosis of early‐stage oral squamous cell carcinoma: A meta‐analysis

“…Thus, future studies should follow the definition of DOI and the cutoff values predefined by AJCC for OSCC, that is, ≤5 mm, >5 mm and ≤10 mm, >10 mm (AJCC, ; Lydiatt et al, ). From the available studies, the only one adopting these cutoff values (Faisal et al, ) reported odds ratio of 1.69 (≤5 mm vs. >5 mm and ≤10 mm), 2.15 (>5 mm and ≤10 mm vs. >10 mm), and 3.63 (≤5 mm vs. >10 mm) for occult lymph node metastasis. Interestingly, one recent study opens a new avenue toward the usefulness of machine learning algorithms in the prediction of occult lymph node metastasis in early‐stage OSCC (Bur et al, ).…”

Depth of invasion for prognostic stratification in oral cavity cancer: do we need further validation?

“…As noted many years ago, nodal metastasis has a profound and dismal impact on prognosis, with a 50% reduction of 5-year DSS in patients showing positive neck nodes (1). DSS for tongue SCC decreases, passing from T2 to T3N0 disease, as the prevalence of loco-regional recurrence greatly increases for an infiltration deeper than 10 mm (10, [14][15][16]. According to many studies, in fact, 10 mm is the threshold of DOI predicting a decline in both DSS and disease-free survival (DFS) for tongue cancer (10,(13)(14)(15).…”

Elective Neck Dissection, but Not Adjuvant Radiation Therapy, Improves Survival in Stage I and II Oral Tongue Cancer with Depth of Invasion >4 mm

“…The cut-off commonly used to stratify patients into low and high risk is 4 mm [2]. DOI is an important prognostic factor for nodal metastasis in oral tongue cancer, with increasing DOI associated with nodal involvement and worse prognosis [3][4][5][6][7].…”

“…Recent studies demonstrated no benefit to adding radiation therapy (RT) for deeper tumors [5][6][7][8][9]. O'steen et al retrospectively evaluated the outcomes of 32 patients with stage N0-2b oral tongue or floor of mouth cancers with the primary tumor not crossing the midline who underwent PORT.…”