Is the 8th edition of the Union for International Cancer Control staging of oral cancer good enough?

Abstract

Depth of invasion is an important predictor of survival. A study by the International Consortium (ICOR) for Outcome Research proposed incorporation of it (together with the greatest surface dimension, or the anatomical criteria, or both) into the T stage. This has been adopted in part by the 8th edition of the Union for International Cancer Control (UICC) TNM 8 classification of malignant tumours for oral squamous cell carcinoma (SCC). Our aim was to verify depth of invasion as an independent prognostic factor, and to validate the staging by comparing it with that specified in the 7th edition (TNM 7) and the T-staging model proposed by the International Consortium. We retrospectively studied 449 patients who had had operations for a previously untreated primary oral cancer between 2006 and 2014 at a single centre, and analysed the independent predictive value of depth of invasion for both disease-specific and overall survival. It was an independent predictor of disease-specific survival as were sex, perineural invasion, and N stage. It was also an independent predictor of overall survival together with sex and N status. Staging in TNM 8 gave a better balance of distribution than that in TNM 7, but did not discriminate between prognosis in patients with T3 and T4 disease. The proposed International Consortium rules for T-staging gave an improved balance in distribution and hazard discrimination. The incorporation of depth of invasion into the T-staging rules for oral SCC improved prognostic accuracy and is likely to influence the selection of patients for adjuvant treatment. Our findings suggest that the TNM 8 staging lacks hazard discrimination in patients with locally-advanced disease because its T4 staging is restricted to anatomical criteria.

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

“…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].…”

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

“…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.…”

“…This was likely due to their small T1 to T2 patient cohort (n = 128). Vuity et al reported their outcomes in 467 patients of OSCC of which 311 patients were T1 to T2 tumours. Their analysis showed a good discrimination between T1 and T2 tumours when compared with the previous staging system.…”

Has the 8th American joint committee on cancer TNM staging improved prognostic performance in oral cancer? A systematic review

“…1 ), which reflects the selection process of the studies during the systematic review. Thirteen articles ( 35 - 47 ) were finally included in the qualitative analysis, all of them being retrospective cohort studies. No additional articles were included from the manual search.…”