1. Tumor Depth of Invasion (Tumor > 4 cm/Depth > 10 mm and Depth > 20 mm) and Through Cortex/Skin Invasion are Both Valid Criteria for Classifying Tumors as pT4a in AJCC 2018 Oral Cavity Cancer Staging System
- Author
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Kai-Ping Chang, Chien-Yu Lin, Chung-Kan Tsao, Lan-Yan Yang, Li-Ang Lee, Chih-Hung Lin, Hung-Ming Wang, Chuen Hsueh, Wan-Ni Lin, Li-Jen Hsin, Yu-Chien Wang, Tuan-Jen Fang, Kang-Hsing Fan, Ku-Hao Fang, Li-Yu Lee, Tzu-Chen Yen, Chung-Jan Kang, Chun-Ta Liao, Shiang-Fu Huang, Chia-Hsun Hsieh, and Shu-Hang Ng
- Subjects
Male ,Skin Neoplasms ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,Prospective Studies ,Oral Cavity Squamous Cell Carcinoma ,Prospective cohort study ,Survival rate ,Aged ,Neoplasm Staging ,Retrospective Studies ,Cancer staging ,Maxillary Neoplasms ,business.industry ,Retrospective cohort study ,medicine.disease ,humanities ,Survival Rate ,Mandibular Neoplasms ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Female ,Mouth Neoplasms ,030211 gastroenterology & hepatology ,Surgery ,Hard palate ,business ,Nuclear medicine ,Follow-Up Studies - Abstract
According to the AJCC third to seventh edition staging manuals (1988-2010), the presence of through cortex and/or skin invasion in oral cavity squamous cell carcinoma (OCSCC) identifies T4a tumors. The AJCC eighth edition (2018) introduced a depth of invasion (DOI) 20 mm as a criterion for pT4a. Subsequently, a revision maintained that tumors 4 cm with a DOI 10 mm should be classified as pT4a. We sought to analyze the prognostic impact of the three distinct criteria identifying pT4a disease.We examined 667 consecutive patients with pT3-4 buccal/gum/hard palate/retromolar SCC who underwent surgery between 1996 and 2016. pT1/pT2 (n = 108/359) disease were included for comparison purposes.The 5-year outcomes of patients with pT1/pT2/without (n = 406)/with tumor 4 cm/DOI 10 mm (n = 261), pT1/pT2/DOI ≤ 20 mm (n = 510)/ 20 mm (n = 157), and pT1/pT2/without (n = 305)/with through cortex/skin invasion (n = 362) were as follows: disease-specific survival (DSS), 98%/89%/79%/65%, p 0.001, 98%/89%/78%/59%, p 0.001, and 98%/89%79%/69%, p 0.001; overall survival (OS), 90%/79%/63%/51%, p 0.001, 90%/79%/63%/42%, p 0.001, and 90%/79%/65%/52%, p 0.001. In pT3-4 disease, a tumor 4 cm/DOI 10 mm was an independent adverse prognosticator for 5-year DSS rate, DOI 20 mm was an independent adverse prognosticator for 5-year DSS and OS rates, whereas through cortex/skin invasion independently predicted 5-year OS rates.All of the three criteria (tumor 4 cm/DOI 10 mm, DOI 20 mm, and through cortex/skin invasion) identify high-risk patients, which should be reflected in further revisions of pT4a classification in OCSCC.
- Published
- 2019