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Virchows Arch. 2018 Oct;473(4):481-487. doi: 10.1007/s00428-018-2417-y. Epub 2018 Jul 23.

Small oral tongue cancers (≤ 4 cm in diameter) with clinically negative neck: from the 7th to the 8th edition of the American Joint Committee on Cancer.

Author information

1
Department of Pathology, University of Helsinki, Haartmaninkatu 3 (P.O. Box 21), FIN-00014, Helsinki, Finland. alhadi.almangush@helsinki.fi.
2
Department of Pathology, University of Turku, Turku, Finland. alhadi.almangush@helsinki.fi.
3
Institute of Dentistry, University of Misurata, Misurata, Libya. alhadi.almangush@helsinki.fi.
4
Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
5
Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
6
Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
7
Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
8
Department of Otorhinolaryngology and Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland.
9
Department of Pathology, University of Helsinki, Haartmaninkatu 3 (P.O. Box 21), FIN-00014, Helsinki, Finland.
10
HUSLAB, Department of Pathology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
11
Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland.
12
Department of Otorhinolaryngology and Head and Neck Surgery, Tampere University Hospital, Tampere, Finland.
13
Department of Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.
14
Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, -SP, Brazil.
15
Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland.
16
Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
17
Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, São Paulo, Brazil.
18
Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
19
Department of Pathology, University of Turku, Turku, Finland.

Abstract

One of the main changes in the 8th edition of the American Joint Committee on Cancer (AJCC) for staging of oral cancer is the inclusion of depth of invasion (DOI) in the T category. However, cancers in different oral subsites have variable behavior, with oral tongue squamous cell carcinoma (OTSCC) being the most aggressive one even at early stage. Thus, it is necessary to evaluate the performance of this new T category in homogenous cohort of early OTSCC. Therefore, we analyzed a large cohort of patients with a small (≤ 4 cm) OTSCC to demonstrate the differences in T stage between the AJCC 7th and 8th editions. A total of 311 early-stage cases (AJCC 7th) of OTSCC were analyzed. We used 5 mm and 10 mm DOI for upstaging from T1 to T2 and from T2 to T3 respectively, as in the AJCC 8th. We further reclassified the cases according to our own proposal suggesting 2 mm to upstage to T2 and 4 mm to upstage to T3. According to AJCC 7th, there were no significant differences in the survival analysis. When we applied the 8th edition, many cases were upstaged to T3 and thus associated with worse disease-specific survival (HR 2.37, 95% CI 1.12-4.99) and disease-free survival (HR 2.12, 95% CI 1.09-4.08). Based on our proposal, T3 cases were associated with even worse disease-specific survival (HR 4.19, 95% CI 2.27-7.74). The 8th edition provides better survival prediction for OTSCC than the 7th and can be further optimized by lowering the DOI cutoffs.

KEYWORDS:

7th AJCC; 8th AJCC; Depth of invasion; Early-stage; Oral tongue cancer

PMID:
30039390
DOI:
10.1007/s00428-018-2417-y
[Indexed for MEDLINE]

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