External validation of the AJCC Cancer Staging Manual, 8th edition, in an independent cohort of oral cancer patients (original) (raw)
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Clinical and Prognostic Significance of the Eighth Edition Oral Cancer Staging System
Cancers
Objectives: The most notable changes in the eighth edition of the AJCC Cancer Staging System include incorporating the depth of invasion (DOI) into T staging and extranodal extension (ENE) into N staging. In this study, we retrospectively assessed the prognostic and clinical implications of the eighth TNM staging system. Materials and Methods: Patients with Oral Squamous Cell Carcinoma (OSCC) who were treated surgically between 2010 and 2017 were retrospectively reviewed. Tumors were first staged according to the seventh edition and restaged using the eighth edition. The prognostic value of the resultant upstaging was evaluated. Results: Integrating the DOI into the T classification resulted in the upstaging of 65 patients, whereas incorporating ENE into the N staging resulted in the upstaging of 18 patients (p < 0.001). Upstaging due to DOI integration had no significant effect on OS or DSS (p > 0.05). Conclusion: Our results demonstrate the importance of incorporating ENE in...
British Journal of Oral and Maxillofacial Surgery, 2018
The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual introduces "depth of invasion" and "extranodal extension" into the head and neck section, and our aim was to find out if these changes have an impact on prognosis. We evaluated 174 patients who had had oral squamous cell carcinomas (SCC) resected between 2003 and 2012. The clinical records were reviewed, the patients' tumours restaged according to the 8th edition of the AJCC, and we analysed five-year survival to verify whether different correlations were made between the T and N stages and disease-specific survival using the 7th and 8th editions. We excluded seven cases because information was incomplete, and the final sample was 167 patients. The five-year overall survival was 68% and the five-year disease-specific survival was 78%. The variable pT was upstaged in 51 patients (31%), and no tumour was downstaged. When we used the 7th edition, the pT category did not correlate with survival (p = 0.055), but when we used the 8th edition, there was a significant association between increased pT categories and disease-specific survival (p = 0.01). In the pN category 23 cases were upstaged (14%) and this affected disease-specific survival using both the 7th and the 8th editions (p = 0.001). When patients were restaged, there was an improvement in discrimination between T categories in relation to disease-specific survival, and confirmation of the prognostic impact of the variable pN. T stage and depth of invasion are complementary predictors of disease-specific survival, and their combination results in the new AJCC staging system giving a better prognosis.
American Journal of Clinical Pathology, 2018
Objectives: We retrospectively compared the seventh and eighth editions of American Joint Committee on Cancer (AJCC) TNM frameworks as disease-free survival (DFS) and overall survival (OS) predictors in oral squamous carcinomas (OSCCs). Methods: We restaged the 342 patients with the revised pT and pN criteria and performed survival analyses. Results: The 3-year DFS (mean follow-up, 364 days; recurrences, 99) was 50%, and the 5-year OS (mean follow-up, 615 days; deaths, 69) was 42%. The eight edition pN classification was an independent multivariate survival predictor. The revised TNM criteria upstaged pT, pN, and stage groupings in 99 (38.8%), 58 (37.3%), and 101 (29.5%) patients. The latter two groups revealed significantly worse DFS and OS compared with those whose categorizations had remained unaltered. In addition, their classification/staging criteria demonstrated superior discrimination, monotonicity, and accuracy for survival estimations. Conclusions: Of the competing AJCC staging criteria, the revised pN classification was the most powerful system to predict OSCC survivals.
Medicinski Pregled, 2019
Introduction. Oral squamous cell carcinoma is the sixth most common carcinoma in the world. Annually, it accounts for 5% of all newly discovered cancers. The most important prognostic factor is the stage of the disease. The tumor, node, and metastasis staging system has been the cornerstone for clinical classification of oral squamous cell carcinoma. Material and Methods. The study included 65 patients with oral squamous cell carcinoma who underwent surgery at the Clinic of Maxillofacial Surgery of the Clinical Center of Vojvodina in Novi Sad. The tumor, node, and metastasis status was determined according to 7 th and 8 th edition of the tumor, node, and metastasis classification. Results. Statistical differences between the 7 th and 8 th edition of tumor, node, and metastasis classification were examined. There was also a change in the nodal status; in 20% of patients there was a transition from N1 to N2, as a result of a more precise definition of nodal status in patients with oral carcinoma. Conclusion. This research has pointed out the significance of tumor size as a predictive factor in oral squamous cell carcinoma, which indicates the importance of its local control (for surgical and radiological treatment). The 8 th edition of the tumor, node, and metastasis classification for oral cavity cancers made a significant shift by clearly defining depth of tumor invasion into the tumor status.
Staging and grading of oral squamous cell carcinoma: An update
Oral Oncology, 2020
Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification.
Histopathology
Addition of tumour infiltration depth and extranodal extension improves the prognostic value of the pathological TNM classification for early-stage oral squamous cell carcinoma. Aims: In the 8th edition of the American Joint Committee on Cancer TNM staging manual, tumour infiltration depth and extranodal extension are added to the pathological classification for oral squamous cell carcinoma. The currently available 8th TNM validation studies lack patients with conservative neck treatment, and changes in the classification especially affect patients with small tumours. The aim of this study was to determine the potential impact of the changes in the 8th edition pTNM classification on the prognosis and treatment strategy for oral squamous cell carcinoma in a well-defined series of pT1-T2 patients with long-term follow-up. Methods and results: Two hundred and eleven first primary pT1-T2 oral squamous cell carcinoma patients, with surgical resection as primary treatment, were analysed retrospectively. One hundred and seventy-three patients underwent a neck dissection, and 38 patients had frequent clinical neck assessments. Long-term follow-up (median 64 months) and reassessed tumour infiltration depth were available. Classification according to the 8th edition criteria resulted in 36% total upstaging with the T classification and 16% total upstaging with the N classification. T3-restaged patients (n = 30, 14%) had lower 5-year disease-specific survival rates than T2staged patients (81% versus 67%, P = 0.042). Postoperative (chemo)radiotherapy could have been considered in another seven (3%) patients on the basis of the 8th edition criteria. Conclusions: Addition of tumour infiltration depth and extranodal extension in the 8th TNM classification leads to the identification of oral squamous cell carcinoma patients with a worse prognosis who might benefit from an improved postoperative treatment strategy.
JAMA otolaryngology-- head & neck surgery, 2014
The current American Joint Committee on Cancer (AJCC) staging system for oral cancer demonstrates wide prognostic variability within each primary tumor stage and provides suboptimal staging and prognostic information for some patients. To determine if a modified staging system for oral cancer that integrates depth of invasion (DOI) into the T categories improves prognostic performance compared with the current AJCC T staging. Retrospective analysis of 3149 patients with oral squamous cell carcinoma treated with curative intent at 11 comprehensive cancer centers worldwide between 1990 and 2011 with surgery ± adjuvant therapy, with a median follow-up of 40 months. We assessed the impact of DOI on disease-specific and overall survival in multivariable Cox proportional hazard models and investigated for institutional heterogeneity using 2-stage random effects meta-analyses. Candidate staging systems were developed after identification of optimal DOI cutpoints within each AJCC T category...
Proposal for modification of the TNM staging classification for cancer of the oral cavity
Journal of Cranio-Maxillofacial Surgery, 1999
Group on Tumours in the Maxillo-Facial Region SUMMARY. Aim. The prognostic value of the TNM and pTNM classi®cations currently used for tumours of the oral cavity is unsatisfactory. A better classi®cation should be aimed at as today's de®nition of T4 leads to overclassi®cation of many tumours and today's de®nition of N3 results in too few lymph nodes in this group. Until 1987 the grade of ®xation of lymph-nodes was part of the N-classi®cation for oral cancer as it is currently used in the N-classi®cation of breast cancer. Methods. From 1987 to 1991 the DO È SAK tumour registry has stored 1532 primary cases of cancer of the oral cavity from 23 hospitals. Crosstables were applied to outline the classi®cation rule for clinical and histopathological T and N based on important factors (T: tumour diameter and thickness; N: lymph node diameter and grade of ®xation; pT: histopathological tumour diameter and thickness; pN: number of lymph nodes involved by the tumour). A Cox model was calculated and combinations of similar prognostic estimates were summarized to the same clinical and histopathological T and N. It was aimed at separating categories and achieving equivalent clinical and histopathological T classi®cations and group frequencies. In a ®nal step a clinical and histopathological stage grouping can be proposed. Results. The gradation of the survival rates shows a marked separation between the T, N and stage categories. The distribution of T, N and stage categories was more uniform when applying the new classi®cation. # 1999 European Association for Cranio-Maxillofacial Surgery * Deutsch-O È sterreichisch-Schweizer Arbeits-Kreis for tumours in the maxillo-facial region.
Postoperative risk stratification in oral squamous cell carcinoma
British Journal of Oral and Maxillofacial Surgery, 2020
Postoperative prognostic stratification using the Union for International Cancer Control (UICC) TNM 8th edition staging rules (UICC 8) may identify additional groups of patients who could benefit from adjuvant radiotherapy. Currently, selection for such treatment is not based on all known prognostic factors, and their relative importance may vary depending on the overall risk category. The objective of this study therefore was to evaluate these possibilities. We retrospectively studied 644 patients who had surgery with curative intent for oral squamous cell carcinoma (OSCC) between March 2006 and February 2017. The outcomes of interest were disease-specific survival (DSS) and locoregional recurrence (LRR). Patients were re-staged according to the UICC 8 staging rules. Putative clinical and pathological prognostic variables were evaluated and hazard ratios estimated. Regression analysis was done to identify independent prognostic factors, and iterative analyses identified clinically-relevant risk categories with a minimum of residual prognostic variables. The significance of recognised pathological prognostic factors differed according to the overall risk category. An intermediate risk group comprising patients with pN1 disease as well those with pT3 disease solely on the basis of a depth of invasion (DOI) of more than 10 mm, was identified. A trial to evaluate the benefit or otherwise of adjuvant radiotherapy in this group is now required. Individual prognostic risk factors should be considered within the context of the overall risk category in patients with OSCC.