External validation of the AJCC Cancer Staging Manual, 8th edition, in an independent cohort of oral cancer patients

Matos, Leandro Luongo de; Dedivitis, Rogério Aparecido; Kulcsar, Marco Aurélio Vamondes; Mello, Evandro Sobroza de; Alves, Venâncio Avancini Ferreira; Cernea, Cláudio Roberto

doi:10.1016/j.oraloncology.2017.05.020

Cited by 67 publications

(68 citation statements)

References 19 publications

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“…This staging was subsequently validated using data from Memorial Sloan‐Kettering and the Princess Margaret Hospital before the publication of the new staging manual . The new staging system has been externally validated in the literature . Matos et al validated the new staging system in their cohort of 298 patients with OSCC.…”

Section: Discussionmentioning

confidence: 99%

Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma

Murthy

Low

Subramaniam

et al. 2018

Journal of Surgical Oncology

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Background To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control. Methods Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease‐specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems. Results The 5‐year OS was 78% and 61% for T1 and T2 tumours, respetively (P < 0.001) (AJCC 7) vs 87% and 67% (P < 0.001) (AJCC 8). The 5‐year DSS was 78% and 61% for T1 and T2, respectively (P < 0.001) (AJCC 7) vs 89% and 71% (P < 0.001) (AJCC 8). For stages I and II tumours the 5‐year OS was 81% and 76%, respectively (P < 0.302) (AJCC 7) vs 87% and 73% (P < 0.017) (AJCC 8). The 5‐year DSS was 83% and 82% (P < 0.222) vs 89% and 77% (P < 0.016). With the AJCC eighth edition the 5‐year local, regional, and distant control rates for T1 vs T2 tumours were 85% vs 74% (P = 0.003), 95% vs 77% (P = 0.001), and 95% vs 80% (P = 0.014), respectively. Conclusion The AJCC 8th staging system provided for more accurate prediction of OS, DSS, and disease control in early oral cavity cancers.

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Section: Discussionmentioning

confidence: 99%

Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma

Murthy

Low

Subramaniam

et al. 2018

Journal of Surgical Oncology

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“…1 The prognostic performance of AJCC8 staging in patients with oral cancer recently was tested. 1,5,6 The new pT stage has been shown to correlate well with overall survival, but these findings reflect the prognostic performance of updated pT staging in a heterogeneous patient population with a variety of oral cavity subsites and pathologic T and N stages of disease (eg, clinically cN0 rather than pN0). The treatment and prognosis of patients with oral cavity carcinoma depends on the oral cavity subsite 7 and neck dissection.…”

Section: Introductionmentioning

confidence: 99%

Early squamous cell carcinoma of the oral tongue with histologically benign lymph nodes: A model predicting local control and vetting of the eighth edition of the American Joint Committee on Cancer pathologic T stage

Sridharan

Thompson

Purgina

et al. 2019

Cancer

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BACKGROUND:The eighth edition of the American Joint Committee on Cancer staging manual (AJCC8) added depth of invasion to the definition of pathologic T stage (pT). In the current study, the authors assess pT stage migration and the prognostic performance of the updated pT stage and compare it with other clinicopathologic variables in patients with early squamous cell carcinoma of the oral tongue (OTSCC; tumors measuring ≤4 cm) with histologically benign lymph nodes (pN0). METHODS: A multi-institutional cohort of patients with early OTSCC was restaged as per AJCC8. Primary endpoints were local recurrence (LR) and locoregional recurrence (LRR). Influential variables were identified and an LR/LRR prediction model was developed. RESULTS: There were a total of 494 patients, with 49 LR and 73 LRR. AJCC8 pT criteria resulted in upstaging of 37.9% of patients (187 of 494 patients), including 34.5% (64 of 185 patients) from pT2 to pT3, without improving the prognostication for LR or LRR. Both LR and LRR were found to be similar for patients with AJCC8 pT2 and pT3 disease. On multivariate analysis, LR was only found to be associated with distance to the closest margin (hazard ratio, 0.36; 95% CI, 0.20-0.64 [P = .0007]) and perineural invasion (hazard ratio, 1.92; 95% CI, 1.10-0.64 [P = .046]). Based on these 2 predictors, a final proportional hazards regression model (which may be used similar to a nomogram) was developed. The proposed model appeared to be superior to AJCC pT stage for estimating the probability of LR and LRR for individual patients with early OTSCC. CONCLUSIONS: AJCC8 pT criteria resulted in pT upstaging of patients with pN0 disease without improved LR or LRR prognostication. The proposed model based on distance to the closest margin and perineural invasion status outperformed pT as a predictor of LR and LRR in patients with early OTSCC. Cancer 2019;125:3198-3207.

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“…On the contrary, a Brazilian retrospective analysis on a cohort of 298 patients with oral cancer confirmed a better correlation of staging/prognosis with the new edition [30]. In this population 22.8% received an upstaging when the depth of invasion was included in the pT classification.…”

Section: Validity Of New Tnmmentioning

confidence: 95%

“…[29]. Moreover, another retrospective evaluation did not report differences between stage I and stage II [30]. In a European cohort Würdemann et al [31] reported no difference in OS rates (p = 0.257) in stage II versus III when applying the new staging rules.…”

Section: Validity Of New Tnmmentioning

confidence: 96%

“…Patients who were upstaged in pT classification presented a worse disease-free survival (DFS) (51.1 vs. 80.4%; p = 0.007) and OS (31.5 vs. 58.6%; p = 0.017). Similarly, those who were upstaged in pN classification presented a worse DFS (17.1 vs. 61.2%; p = 0.001) and OS (8.5% versus 37.9%; p < 0.001) [30]. Table 5 summarizes the controversial results of studies on the new TNM [9,10,28,[31][32][33][34].…”

Section: Validity Of New Tnmmentioning

confidence: 99%

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Pros and Cons of the New Edition of TNM Classification of Head and Neck Squamous Cell Carcinoma

Denaro

Russi

Merlano³

2018

Oncology

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The TNM classification is a worldwide standard staging system used to define the extent of cancer and is a major prognostic factor in predicting the outcome of patients. The TNM Classification of Malignant Tumours, 8th edition, has been used since January 1, 2018. In the area of head and neck cancer major modifications were produced: important updated T and N modification for oral cavity and nasopharyngeal cancer, the introduction of clinical and pathological stages for neck disease, and a new HPV-16-positive HNSCC classification. While until a few years ago the TNM staging system classified prognostic risk groups based on tumour size, the 8th edition responds to the need to categorize the prognosis of patients with similarly sized tumours but with very different clinical and biological behaviour. This review details TNM changes and the clinical need for these modifications, valuating possible limits in daily applicability.

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External validation of the AJCC Cancer Staging Manual, 8th edition, in an independent cohort of oral cancer patients

Cited by 67 publications

References 19 publications

Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma

Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma

Early squamous cell carcinoma of the oral tongue with histologically benign lymph nodes: A model predicting local control and vetting of the eighth edition of the American Joint Committee on Cancer pathologic T stage

Pros and Cons of the New Edition of TNM Classification of Head and Neck Squamous Cell Carcinoma

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