Comparison of Tumor Classifications for Cutaneous Squamous Cell Carcinoma of the Head and Neck in the 7th vs 8th Edition of the AJCC Cancer Staging Manual

Abstract

IMPORTANCE Previous studies have shown that the AJCC Cancer Staging Manual, 7th edition (AJCC 7), tumor classification for cutaneous squamous cell carcinoma (CSCC) failed to accurately stratify disease-related outcomes. The recently released 8th edition (AJCC 8) features a revised tumor classification for only head and neck CSCC (HNCSCC).OBJECTIVE To compare AJCC 7 and AJCC 8 tumor classifications for HNCSCC and to validate AJCC 8. DESIGN, SETTING, AND PARTICIPANTS This was a 10-year retrospective cohort study (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) at an academic tertiary care center reviewing 680 primary HNCSCC tumors in 459 patients. MAIN OUTCOMES AND MEASURESPrimary HNCSCC tumors were reviewed for disease-related outcomes (DROs): local recurrence (LR), nodal metastasis (NM), and disease-specific death (DSD). Tumors were stratified by AJCC 7 and AJCC 8 tumor classification. Distinctiveness (outcome differences between categories), homogeneity (outcome similarity within categories), and monotonicity (outcome worsening with increasing categories) were assessed for both classifications. RESULTS Most of the 459 patients were white (451 [98.3%]) and male (312 [68.0%]). AJCC 8 high tumor categories (T3/T4) accounted for 121 (17.8%) of total cases but 50 of 71 DROs (70.4%) (22 of 34 of LRs [64.7%], 17 of 24 NMs [70.8%], and 11 of 13 of DSDs [84.6%]). This was a significant improvement over AJCC 7, where only 12 of 71 DROs (16.9%) (4 of 34 LRs [11.8%], 3 of 24 NMs [12.5%], and 5 of 13 DSDs [38.5%]) occurred in T3/T4 categories.However, AJCC 8 T2 and T3 were indistinct, with overlapping 95% CIs for 10-year cumulative incidences of LR, NM, and DSD. The 10-year cumulative incidence of DROs in the 119 AJCC 8 T3 cases were 19.7% (95% CI, 13.0%-29.7%) for LR, 14.1% (95% CI, 9.7%-20.7%) for NM, and 9.3% (95% CI, 6.8%-14.0% for DSD).CONCLUSIONS AND RELEVANCE AJCC 8 demonstrates superior homogeneity and monotonicity compared with AJCC 7. It now may be possible for AJCC 8 HNCSCC T2, T3, and T4 cases to be recorded and tracked by tumor registries because they represented a 23.1% subset in this study, which includes nearly all poor outcomes (85.9%). Further work is needed to validate AJCC 8 with population-level data and to compare AJCC 8 performance against alternative tumor classifications.

Metastasis of cutaneous squamous cell carcinoma in organ transplant recipients and the immunocompetent population: is there a difference? a systematic review and meta‐analysis

“…Instead, it is described as a prognostic factor to take into account for clinical practice. [92][93][94] However, the pooled risk of metastasis per cSCC was lower, as patients often develop multiple lesions, especially OTR. In this analyses, the risk for a single cSCC to metastasize in OTR is lower compared to the immunocompetent population.…”

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European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

“…The UICC uses a separate TNM classification for non-head and neck cSCC (Table 6) and head and neck cSCC (Table 7), while the AJCC has only been developed for head and neck cancers (Tables 7 and 8). The 8th edition AJCC staging system (AJCC8) was reported to perform better compared to the 7th edition [110]. However, AJCC8 needs further refinement, as T4 classification is rarely used because very few tumors meet the inclusion criteria and some T2 tumors may be associated with poor outcomes, as noted in cases of poorly differentiated tumors [110] Another major limitation of the AJCC/UICC staging systems is the heterogeneity of stage III that includes both patients with lymph node metastasis and patients with primary cSCC only.…”