Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation

doi:10.19438/j.cjoms.2021.02.008

Abstract

Abstract: PURPOSE: To analyze and compare the significance of the American Joint Committee on Cancer (AJCC) eighth edition and seventh edition of TNM staging system in clinical treatment decision-making, prognosis stratification and improving the accuracy of prognosis evaluation of oral cancer. METHODS: A retrospective cohort study of patients with oral squamous cell carcinoma(OSCC) from 2009 to 2015 was performed, and AJCC seventh and eighth edition of staging systems was applied to all patients. Overall survival and disease-specific survival were analyzed by Kaplan-Meier analysis and Log-rank test with SPSS 26.0 software package. Concordance index and Akaike information criterion was used to calculate the system's prognostic accuracy. RESULTS: In total, 570 patients were followed up with a median follow-up age of 64 years. The median follow-up peroid was 38 months. The tumor stage of 146 (25.61%) patients was changed by depth of invasion and extranodal extension. Overall survival and disease-specific survival model analysis of T stage and TNM stage showed that the Akaike information criterion of AJCC eighth edition staging systems was significantly lower than the seventh edition and concordance index was significantly higher than the seventh edition(P<0.05). CONCLUSIONS: Depth of invasion and extranodal extension were added to the TNM staging of oral cancer in the AJCC eighth edition of staging systems. These two indices have changed the pathological stages of many patients according to the original standard staging. The results showed that when depth of invasion is 6.25 mm, it can well predict cervical lymph node metastasis, and is also the optimal cut-off for predicting overall survival and disease-specific survival. The new staging system has more guiding significance for clinical decision-making and prognosis evaluation of oral cancer patients, especially for advanced patients.

Key words: Oral cancer, Squamous cell carcinoma, AJCC seventh edition, AJCC eighth edition, TNM stage, Prognosis

CLC Number:

R739.8

ZHOU Kai, LI Heng-yong, QI Xiao-jie, GE Sheng-you, KONG Yu, SONG Kai, FENG Yuan-yong, HOU Feng, SHI Hai-lei, JIANG Yan-xia, SHANG Wei. Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation[J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(2): 138-145.

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