Prognosis of oral cancer: a comparison of the staging systems given in the 7th and 8th editions of the American Joint Committee on Cancer Staging Manual (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...
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...
Is the 8th edition of the Union for International Cancer Control staging of oral cancer good enough?
British Journal of Oral and Maxillofacial Surgery, 2018
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.
Oral oncology, 2017
To evaluate the new American Joint Committee on Cancer (AJCC) cancer staging manual (8th edition) in an independent cohort of patients surgically treated for oral squamous cell carcinoma in order to determine whether the upstaging of pT and pN classification was indicative of a worse prognosis. A cohort of 298 patients was analyzed retrospectively. Of these patients, 22.8% received an upstaging when the depth of invasion was included into the pT classification. Similarly, 29.2% of them were upstaged when extracapsular extension was added to pN classification. Twenty-eight of 68 patients (41.2%) that received an upstaging of pT classification died, and 23 (33.8%) experienced disease recurrence compared to 98/229 (42.8%) and 68/229 (29.7%), respectively, for those with the same pT during follow-up. With regard to pN classification, 70.6% of upstaged patients (60/85) died, and 50.6% (43/85) developed recurrence of the disease compared to 63/205 (30.7%) and 42/205 (20.5%), respectively,...
Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma
Journal of Surgical Oncology, 2018
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.
Tumor budding and depth of invasion can be used as prognostic risk factors in determining treatment plan for early stage oral squamous cell carcinoma, 2019
Background: The grading of oral squamous cell carcinoma can be useful along with TNM staging in determining treatment plan. The aim is to evaluate the prognostic value of histopathological grading of oral squamous cell carcinoma and to find its importance in setting appropriate treatment plan. Methods: The study includes 60 oral squamous cell carcinoma cases surgically operated during January 2012 to December 2018. From the archival paraffin blocks and available resected specimens of each case, the histological parameters used in Bryne’s invasive grading system and Almangush BD model were evaluated and compared to their prognosis. Results: The parameters used in BD model-tumor budding and depth of invasion were found to be statistically significant with prognosis of the disease. Except for nuclear polymorphism, the parameters used in Bryne’s invasive front grading system do not correlate with prognosis. Conclusion: Based on the prognostic significance, tumor budding ≥5 buds in the invasive front area and depth of invasion ≥4mm can be used as risk factors in prospective clinical trials by considering them in early stage disparity cases for multimodality treatment approach and elective neck dissection.
Prognostic and predictive factors in oral cancer: the role of the invasive tumour front
Journal of Oral Pathology and Medicine, 2000
Most decisions for cancer patients are now made on the basis of prognostic and predictive factors. However, due to the limited prognostic value of conventional tumour/nodal/ metastasis staging and histopathological grading in oral cancer, a large group of patients are still over-or under-treated with significant personal and socioeconomical impact. Recent work indicates that morphological and functional characteristics of the invasive tumour front underlie the biological aggressiveness of oral cancer. Incorporation of these concepts into a prognostic system will better reflect the biologic diversity of oral cancer and more accurately predict clinical outcomes and responses to particular types of adjuvant therapy.