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

• Published in: Virchows Archiv : an international journal of pathology 2018-10, Vol.473 (4), p.481-487
• Main Authors: Almangush, Alhadi, Mäkitie, Antti A., Mäkinen, Laura K., Kauppila, Joonas H., Pukkila, Matti, Hagström, Jaana, Laranne, Jussi, Soini, Ylermi, Kowalski, Luiz Paulo, Grénman, Reidar, Haglund, Caj, Coletta, Ricardo D., Salo, Tuula, Leivo, Ilmo
• Format: Article
• Language: English
• Subjects: Cancer; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Disease-Free Survival; Female; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Kaplan-Meier Estimate; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Neck; Neoplasm Invasiveness; Neoplasm Staging - methods; Oral cancer; Original Article; Pathology; Predictive Value of Tests; Proportional Hazards Models; Reproducibility of Results; Retrospective Studies; Risk Factors; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck; Survival; Survival analysis; Time Factors; Tongue; Tongue Neoplasms - mortality; Tongue Neoplasms - pathology; Tongue Neoplasms - therapy; Tumor Burden
• ISSN: 0945-6317; 1432-2307; 1432-2307
• DOI: 10.1007/s00428-018-2417-y

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.