Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Depth of Invasion

Ebrahimi, Ardalan; Gil, Ziv; Amit, Moran; Yen, Tzu‐Chen; Liao, Chun‐Ta; Chaturvedi, Pankaj; Agarwal, Jai Prakash; Kowalski, Luiz Paulo; Kreppel, Matthias; Cernea, Cláudio Roberto; Brandão, José; Bachar, Gideon; Villaret, Andrea Bolzoni; Fliss, Dan M.; Fridman, Eran; Robbins, K. Thomas; Shah, Jatin P.; Patel, Snehal G.; Clark, Jonathan

doi:10.1001/jamaoto.2014.1548

Cited by 250 publications

(174 citation statements)

References 34 publications

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“…3,4 In the current study, we vetted the new pT staging in a multiinstitutional cohort of patients with pN0 early oral tongue SCC. 9 AJCC8 also attempts to transition from classic population-based staging to a more personalized staging to assist with therapeutic decisions for individual patients.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Tumors with depth of invasion ≤5 mm are classified as T1, those with depth of invasion >5 mm but ≤10 mm are classified as T2, and those with depth of invasion >10 mm are classified as T3. 5 This served to distinguish the difference between thick exophytic tumors with limited depth of invasion from those with limited diameter but extensive infiltration, previously identified as a limitation of the previous AJCC TNM classification system. 5 This served to distinguish the difference between thick exophytic tumors with limited depth of invasion from those with limited diameter but extensive infiltration, previously identified as a limitation of the previous AJCC TNM classification system.…”

Section: Introductionmentioning

confidence: 99%

Adverse pathologic features in T1/2 oral squamous cell carcinoma classified by the American Joint Committee on Cancer eighth edition and implications for treatment

et al. 2018

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“…Secondly, tumor thickness or depth of invasion was not recorded or analyzed. In patients with cN0 OSCC, depth of invasion has been considered in future versions of the AJCC TNM staging system according to high incidence of occult metastasis (27,28). Thirdly, considering the economic status or emotional reasons of the patients in developing countries, including China, END is more extensively used than OBS.…”

Section: Discussionmentioning

confidence: 99%

Neck observation versus elective neck dissection in management of clinical T1/2N0 oral squamous cell carcinoma: a retrospective study of 232 patients

Liu

Lao

Liang

et al. 2017

Chinese Journal of Cancer Research

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ObjectiveThe management of early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation (OBS) and elective neck dissection (END) in treating patients with cT1/2N0 OSCC.MethodsA total of 232 patients with cT1/2N0 OSCC were included in this retrospective study. Of these patients, 181 were treated with END and 51 with OBS. The survival curves of 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were plotted using the Kaplan-Meier method for each group, and compared using the Log-rank test.ResultsThere was no significant difference in 5-year OS and DSS rates between END and OBS groups (OS: 89.0% vs. 88.2%, P=0.906; DSS: 92.3% vs. 92.2%, P=0.998). However, the END group had a higher 5-year RFS rate than the OBS group (90.1% vs. 76.5%, P=0.009). Patients with occult metastases in OBS group (7/51) had similar 5-year OS rate (57.1% vs. 64.1%, P=0.839) and DSS rate (71.4% vs. 74.4%, P=0.982) to those in END group (39/181). In the regional recurrence patients, the 5-year OS rate (57.1% vs. 11.1%, P=0.011) and DSS rate (71.4% vs. 22.2%, P=0.022) in OBS group (7/51) were higher than those in END group (9/181). ConclusionsThe results indicated that OBS policy could obtain the same 5-year OS and DSS as END. Under close follow-up, OBS policy may be an available treatment option for patients with clinical T1/2N0 OSCC.

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Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Depth of Invasion

Abstract: We propose an improved oral cancer T staging system based on incorporation of DOI that should be considered in future versions of the AJCC staging system after external validation.

Cited by 250 publications

References 34 publications

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

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

Adverse pathologic features in T1/2 oral squamous cell carcinoma classified by the American Joint Committee on Cancer eighth edition and implications for treatment

Neck observation versus elective neck dissection in management of clinical T1/2N0 oral squamous cell carcinoma: a retrospective study of 232 patients

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