Abstract
AimsIn the 8th edition of the American Joint Committee on Cancer TNM staging manual, tumour infiltration depth and extranodal extension are added to the pathological classification for oral squamous cell carcinoma. The currently available 8th TNM validation studies lack patients with conservative neck treatment, and changes in the classification especially affect patients with small tumours. The aim of this study was to determine the potential impact of the changes in the 8th edition pTNM classification on the prognosis and treatment strategy for oral squamous cell carcinoma in a well‐defined series of pT1–T2 patients with long‐term follow‐up.Methods and resultsTwo hundred and eleven first primary pT1–T2 oral squamous cell carcinoma patients, with surgical resection as primary treatment, were analysed retrospectively. One hundred and seventy‐three patients underwent a neck dissection, and 38 patients had frequent clinical neck assessments. Long‐term follow‐up (median 64 months) and reassessed tumour infiltration depth were available. Classification according to the 8th edition criteria resulted in 36% total upstaging with the T classification and 16% total upstaging with the N classification. T3‐restaged patients (n = 30, 14%) had lower 5‐year disease‐specific survival rates than T2‐staged patients (81% versus 67%, P = 0.042). Postoperative (chemo)radiotherapy could have been considered in another seven (3%) patients on the basis of the 8th edition criteria.ConclusionsAddition of tumour infiltration depth and extranodal extension in the 8th TNM classification leads to the identification of oral squamous cell carcinoma patients with a worse prognosis who might benefit from an improved postoperative treatment strategy.
Highlights
In 2016, the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging manual was released.[1]
These studies differed from the current study by using sentinel lymph node biopsy (SLNB)-staged patients or by analysing only the pT categories and not the pN categories
This study confirms the previously mentioned validation study findings regarding the shorter survival rate of patients restaged as pT3 and pN3 with the 8th edition criteria.[2,4,5]
Summary
In 2016, the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging manual was released.[1]. The incorporation of tumour infiltration depth and ENE in the pathological TNM classification was based on data from both the International Consortium for Outcome Research in Head and Neck Cancer (ICOR) (n = 3149) and the National Cancer Data Base (n = 7264).[2,3] The 8th edition has been validated in various independent databases: the pT and pN classifications by Lydiatt et al.[2] (n = 1792) and Matos et al.[4] (n = 298), and the pN classification by Garcia et al.[5] (n = 1137) These studies confirmed a better prediction of survival per stratification with the 8th pTNM classification edition, whereby patients who had been upstaged because of the incorporation of tumour infiltration depth and ENE generally had lower survival rates
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