AJCC 8th Edition oral cavity squamous cell carcinoma staging – Is it an improvement on the AJCC 7th Edition?

Hinton-Bayre, Anton; Friedland, Peter; Farah, Camile S.

doi:10.1016/j.oraloncology.2018.04.018

Cited by 72 publications

(64 citation statements)

References 21 publications

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“…We demonstrated that DOI led to upstaging in 16.6% of patients, whereas pENE led to upstaging in 13.3% of patients; the overall stage was changed in 24.8% of patients. Furthermore, we demonstrated less stage migration from AJCC 7 pT2 to AJCC 8 pT3 in our cohort (16.4%) than Ebrahimi et al (46.8%) and Pollaers et al (50%) in their international and Australian cohorts, and this suggests that, if anything, our study may be underestimating the impact of stage migration.…”

Section: Discussioncontrasting

confidence: 61%

Pathologic staging changes in oral cavity squamous cell carcinoma: Stage migration and implications for adjuvant treatment

Lee

Eskander

Park

et al. 2019

Cancer

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BACKGROUND:The eighth edition of the AJCC Cancer Staging Manual (AJCC 8) incorporates depth of invasion (DOI) into the pathologic tumor (pT) classification and pathologic extranodal extension (pENE) into the pathologic nodal (pN) classification for oral cavity squamous cell carcinoma (OCSCC). This study evaluated the incidence and prognostic importance of stage migration as a result of these changes in the AJCC 8 staging system. METHODS: From the National Cancer Database, cohorts were identified from patients with OCSCC undergoing definitive surgery between 2004 and 2013 for pT (n = 7184), pN (n = 13,627), and pathologic stage (pStage) analysis (n = 5580). RESULTS: DOI and pENE were prognostic in all groups except for pN3 according to the seventh edition of the AJCC Cancer Staging Manual (AJCC 7). Upstaging was seen in 12.4% of patients for the pT classification, in 13.3% for the pN classification, and in 24.8% for the overall pStage grouping. Notably, upstaging led to similar or improved 5-year overall survival (OS) for every AJCC 8 pT/N classification except pStage IVB. Patients with AJCC 7 pT1 tumors that were upstaged to AJCC 8 pT3 tumors had improved OS in comparison with the remainder of the pT3 group (71.7% vs 43.7%; P < .0001). A multivariable analysis of upstaged pT3N0 patients demonstrated a reduced risk of death with the receipt of postoperative radiotherapy (PORT; hazard ratio, 0.56; 95% confidence interval, 0.33-0.95; P = .03). CONCLUSIONS: Upstaging is common in AJCC 8, and patients with upstaged tumors demonstrate improved survival; these factors should be kept in mind when one is interpreting data with the new staging system. PORT may reduce deaths among newly upstaged pT3N0 patients, and further study is needed in this area. Cancer 2019;125:2975-2983.

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Section: Discussioncontrasting

confidence: 61%

Pathologic staging changes in oral cavity squamous cell carcinoma: Stage migration and implications for adjuvant treatment

Lee

Eskander

Park

et al. 2019

Cancer

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“…Traditional tumor staging (AJCC/UICC‐TNM classification) regime is routinely employed to predict clinical outcomes of patients with OSCC after radical resection (Chinn & Myers, ). However, significant differences in prognosis are usually observed in patients with same TNM stages, thus indicating that TNM staging remains far from optimal in prognostic assessment in the clinic (Okuyemi, Piccirillo, & Spitznagel, ; Pollaers, Hinton‐Bayre, Friedland, & Farah, ). Current TNM regime based on tumor size, the presence of cervical lymph node metastasis, and distant metastasis is not sufficient to accurately predict the prognosis of OSCC (Chinn & Myers, ).…”

Section: Introductionmentioning

confidence: 99%

Preoperative circulating platelet, neutrophil, and lymphocyte counts predict survival in oral cancer

Diao

et al. 2019

Oral Diseases

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Objective: Circulating immune-inflammatory cells have been increasingly recognized as robust prognostic biomarkers in cancer. Here, we sought to evaluate the prognostic values of preoperative peripheral platelet, neutrophil, lymphocyte quantitation in patients with primary oral squamous cell carcinoma (OSCC). Materials and methods:A total number of 309 patients with primary OSCC surgically treated at our institutions were retrospectively included. Detailed demographic, clinicopathological, laboratory, and follow-up data were collected. The Kaplan-Meier analysis and Cox regression assay were performed to assess the prognostic values. A new prognostic risk score was developed and designed as PNL (platelet-neutrophillymphocyte) score based on combined preoperative platelets, neutrophils, and lymphocytes via calculating the regression coefficients of each type of cell by Cox regression analysis.Results: High platelet counts (≥266 × 10 9 /L), neutrophil counts (≥2.8 × 10 9 /L), PNL scores, and low lymphocyte counts (<1.4 × 10 9 /L) significantly associated with reduced overall and disease-free survival (Kaplan-Meier, p < 0.05, Log-rank test).Univariate and multivariate regression analyses revealed that individual platelet, neutrophil, lymphocyte quantitation, and PNL score were independent prognostic predictors for patient survival. Moreover, receiver operating characteristics curve revealed superior prognostic utility of PNL score for OSCC. Conclusions:Our findings indicate that preoperative circulating platelets, neutrophils, lymphocytes, and PNL score serve as noninvasive, low-cost, and powerful prognostic predictors for patients with OSCC.

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“…Globally over the last twenty years, there has been increasing incidence of oral cancer throughout the developed world including Australia, New Zealand, North America, Europe and parts of East Asia . The reported five‐year survival rate of stage III or IV oral cancer ranges between 15% and 55% . Although survival rates have improved in the last 3 decades in developed countries, these remain low in developing countries.…”

Section: Introductionmentioning

confidence: 99%

“…Although survival rates have improved in the last 3 decades in developed countries, these remain low in developing countries. In Australia, the 5‐year overall survival rate ranges from 25% to 84.6%, while the 5‐year disease‐free survival rate ranges from 25% to 73.7% depending on disease stage . The most important prognostic marker for oral cancer is still tumour stage at diagnosis .…”

Section: Introductionmentioning

confidence: 99%

Missed opportunities for oral cancer screening in Australia

Webster

Batstone

Farah³

2019

J Oral Pathology Medicine

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Objectives Most patients with oral cancer lack early symptoms, therefore most present with advanced stage of disease. Early detection of oral cancer and oral potentially malignant disorders (OPMDs) in the asymptomatic phase via an opportunistic oral cancer screening examination is important as survival rates are significantly improved if the disease is treated at an earlier stage. The objective is to identify opportunities to achieve early stage diagnosis of oral cancer in Australian patients. Materials and Methods A cohort of 103 patients newly diagnosed with oral cancer were surveyed at a tertiary hospital Head and Neck Clinic. Patient awareness, knowledge, risk factors and diagnostic delay in oral cancer diagnosis were investigated. The asymptomatic period before diagnosis was studied to identify opportunities for improving opportunistic screening rates in Australia. Results Australian patients have poor awareness of oral cancer with 46% having never heard of oral cancer, and poor knowledge of risk factors for oral cancer. Only 7% were diagnosed in the asymptomatic phase and all by dental practitioners. Once symptomatic, median diagnostic delay was 9 weeks. In the asymptomatic phase before diagnosis, patients attended general medical practitioners far more often than general dental practitioners. Both groups rarely discussed risk factors for oral cancer (<10%) or performed opportunistic oral cancer screening examinations (<10%) with their patients. Conclusion Asymptomatic diagnosis of oral cancer at an earlier stage of disease is possible in the primary medical setting but increased awareness and knowledge are required in both patients and health practitioners.

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AJCC 8th Edition oral cavity squamous cell carcinoma staging – Is it an improvement on the AJCC 7th Edition?

Cited by 72 publications

References 21 publications

Pathologic staging changes in oral cavity squamous cell carcinoma: Stage migration and implications for adjuvant treatment

Pathologic staging changes in oral cavity squamous cell carcinoma: Stage migration and implications for adjuvant treatment

Preoperative circulating platelet, neutrophil, and lymphocyte counts predict survival in oral cancer

Missed opportunities for oral cancer screening in Australia

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