Depth of invasion in early oral cancers- is it an independent prognostic factor?

D’Cruz, Anil; Dhar, Harsh; Vaish, Richa; Hawaldar, Rohini; Gupta, Sudeep; Pantvaidya, Gouri; Chaukar, Devendra; Chaturvedi, Pankaj; Pai, Prathamesh; Deshmukh, Anuja; Kane, Shubhada; Nair, Deepa; Nair, Sudhir; Ghosh‐Laskar, Sarbani; Agarwal, Jitendra

doi:10.1016/j.ejso.2021.03.243

Cited by 12 publications

(12 citation statements)

References 15 publications

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confidence: 53%

“…D'Cruz et al demonstrated stage migration in 44.38% of patients with early oral cancer, 49.9% of T1 (40.6% upstaged to new T2 and 9.3% to new T3), and 32.6% of T2 lesions. In their study, 84.9% patients were tongue cancer (D'Cruz et al., 2021). Our results showed, compared with the 7th AJCC, 15.39% of T1 (12.02% upstaged to new T2 and 3.37% to new T3) and 13.46% of T2 upstaged in patients with early‐stage (the 8th AJCC) TSCC.…”

Section: Discussionmentioning

confidence: 93%

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Comparative study on classifications of AJCC 8th and 7th in the patients with tongue squamous cell carcinoma

et al. 2022

Oral Diseases

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Objectives Depth of invasion (DOI) is the most important predictor for lymph node metastasis in early‐stage oral cancer. This study aims to investigate the effects of the different classifications of AJCC 7th and 8th on predicting lymph node metastasis and the optimal cutoff point for DOI predicting the lymph node metastasis in patients with tongue squamous cell carcinoma (TSCC). Materials and methods We performed a retrospective study in 208 TSCC patients in early T stage without clinical or radiological signs of lymph node metastasis. Those patients were treated with elective neck dissection (END) between April 2019 and December 2020. And the relation between DOI and lymph node metastasis was analyzed. Results Metastases were found in 58 of 208 patients (27.88%). Of those 58 patients, the mean DOI was 8.311 mm compared to 5.425 mm in patients without metastases (p < 0.0001). The receiver operating characteristic curve (ROC curve) showed an area under the curve of 0.7066 with the most optimal cutoff point on a DOI of 4.050 mm (sensitivity 86.21%, specificity 52%). Linear regression analysis (1 mm ≤ DOI ≤6 mm) revealed that a DOI ≥ 3.211 mm predicated an incidence of occult lymph node metastasis greater than 20%. Regional metastases were found in 12.82% of patients with DOI ≤ 4.0 mm. Within the entire cohort, 60 cases (28.85%) got upgraded with respect to T stage. No tumor underwent downstaging. Conclusion The 8th edition provides better lymph node metastasis prediction for TSCC than the 7th. And DOI is a poor predictor for regional metastasis in patients with early T stage clinically node‐negative TSCC. END in patients with early‐stage TSCC should be performed in patients with DOI ≥ 3.211 mm.

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supporting

confidence: 53%

Section: Discussionmentioning

confidence: 93%

Comparative study on classifications of AJCC 8th and 7th in the patients with tongue squamous cell carcinoma

et al. 2022

Oral Diseases

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“…While no previous study has specifically compared overall survival for individual T stage subgroups (e.g., tumors <2 cm and DOI <5 mm vs. tumors <2 cm and DOI >5 mm), D'Cruz et al reported 5-year overall survival of 79% for tumors ≤2 cm in size with DOI <5 mm, and 68.5% for tumors ≤2 cm in size with DOI >5 mm. 17 In the present study, 5-year overall survival for tumors ≤2 cm stratified by DOI ≤5 mm versus >5 mm was 73.5% and 66.1%, respectively. One of strengths of the present study was its inclusion and representation of tumors located in all subsites of the oral cavity.…”

Section: Discussionmentioning

confidence: 42%

“…3 This study's finding of DOI as an independent prognostic factor associated with lower overall survival builds upon previous literature that has demonstrated the association of DOI with worse overall survival, disease-specific survival, local recurrence free survival, and disease specific mortality. [10][11][12]15,[19][20][21] Other studies have also indirectly evaluated the impact of DOI on survival by comparing the predictive value of the 7th edition versus 8th edition staging guidelines, [4][5][6][7]9,16,17 once again supporting the inclusion of DOI in the current T staging criteria. While no previous study has specifically compared overall survival for individual T stage subgroups (e.g., tumors <2 cm and DOI <5 mm vs. tumors <2 cm and DOI >5 mm), D'Cruz et al reported 5-year overall survival of 79% for tumors ≤2 cm in size with DOI <5 mm, and 68.5% for tumors ≤2 cm in size with DOI >5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Despite tumors of the oral tongue only comprising 41.2%-41.7% of all OCSCCa, 13,14 further studies of DOI have either solely evaluated tumors of the oral tongue and generalized these results for all subsites of the oral cavity 9,10,15 or similarly grouped all oral cavity tumors in their analysis. [4][5][6][7]16,17 In this study, we aim to be the first to investigate the prognostic value of DOI stratified by oral cavity subsite, by evaluating the current AJCC 8th edition prognostic cutoffs of DOI 5 mm for tumors ≤2 cm in size and DOI 10 mm for tumors >2 cm in size.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating depth of invasion across oral cavity subsites as part of the AJCC 8th edition T staging criteria for oral cavity squamous cell carcinoma

Gilja,

Barlow,

Kumar

et al. 2023

Head & Neck

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BackgroundThe prognostic impact of depth of invasion (DOI) in American Joint Committee on Cancer 8th edition TNM staging for oral cavity squamous cell carcinoma (OCSCCa) across oral cavity subsites is unknown.MethodsOverall survival of patients with pT1‐4a OCSCCa in the National Cancer Database (2010–2017), stratified by tumor size and DOI across eight oral cavity subsites, was evaluated using multivariable‐adjusted Cox proportional hazards modeling.ResultsWhen stratified by tumor size ≤2 cm and >2 cm, DOI >5 mm and DOI >10 mm were only associated with worse overall survival, respectively, for tumors of the oral tongue (Tumor size ≤2 cm, DOI >5 mm v DOI ≤5 mm: HR: 1.31, 95% CI: 1.12–1.53, p < 0.001; Tumor size >2 cm, DOI >10 mm v DOI ≤10 mm: HR: 1.15, 95% CI: 1.01–1.30, p = 0.03). DOI >5 mm and DOI >10 mm was not prognostic for any other tumor location.ConclusionsThese findings suggest that the current staging schema for DOI in OCSCCa may not be prognostic across all oral cavity subsites.

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Intraoperative Ultrasound for the Management of Oral Tongue Cancer: a Systematic Review and Meta‐Analysis

Spence,

Au,

Zhao

et al. 2024

OTO Open

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ObjectiveTo evaluate for correlation between intraoperative ultrasound (IOUS)‐measured tumor thickness (TT) (uTT) and histopathological TT (hTT), and to compare IOUS‐assisted resection with conventional resection in patients with oral tongue cancers.Data SourcesOvid MEDLINE (1946‐2023), Embase.com (1947‐2023), and Web of Science (All Databases 1900‐2023).Review MethodsInclusion criteria were the use of IOUS for the management of oral tongue cancer. Studies that did not report quantitative data were excluded. Additionally, studies that were not contributory to meta‐analysis, or a narrative analysis of pooled results were excluded. Selection was carried out by 2 reviewers. A total of 2417 studies were initially identified, with 12 ultimately being included in this review, and 7 included in the meta‐analysis. Data were extracted by 2 investigators and were pooled using a random‐effects model.ResultsOur meta‐analysis reveals a pooled correlation coefficient of 0.92 (95% confidence interval: 0.80‐0.96) for studies comparing uTT to hTT. Studies comparing IOUS‐assisted resection to conventional resection found IOUS‐assisted resection yielded wider nearest margins in all studies reporting this outcome.ConclusionIOUS reliably measures TT, similarly to that of histopathology measurement. IOUS‐assisted resection, which allows the surgeon to view the deep extent of tumor invasion, may increase closest radial margin distance compared to conventional resection. IOUS‐assisted resection may represent a more reliable approach to achieving clear margins than conventional resection.

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Depth of invasion in early oral cancers- is it an independent prognostic factor?

Cited by 12 publications

References 15 publications

Comparative study on classifications of AJCC 8th and 7th in the patients with tongue squamous cell carcinoma

Comparative study on classifications of AJCC 8th and 7th in the patients with tongue squamous cell carcinoma

Evaluating depth of invasion across oral cavity subsites as part of the AJCC 8th edition T staging criteria for oral cavity squamous cell carcinoma

Intraoperative Ultrasound for the Management of Oral Tongue Cancer: a Systematic Review and Meta‐Analysis

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