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Clinical Outcomes in pT4 Tongue Carcinoma are Worse than in pT3 Disease: How Extrinsic Muscle Invasion Should be Considered?

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The identification of extrinsic tongue muscle invasion in oral cavity cancer remains challenging. Notably, the most recent American Joint Committee on Cancer (AJCC 2017, 8th edition) staging manual indicates that extrinsic muscle invasion does not lead to the diagnosis of a T4 tumor. Because this approach carries the risk of tumor downstaging, we compared the clinical outcomes of patients with oral tongue squamous cell carcinoma (SCC) staged as pT3 vs. pT4 according to the AJCC 2010, 7th edition criteria.

Methods

We retrospectively examined the records of consecutive patients with pT3 (n = 135) and pT4 (n = 68) tongue SCC who underwent radical surgery. Of the 68 pT4 tongue SCC, 63 (93%) had extrinsic muscle involvement alone. The 5-year locoregional control (LRC), distant metastasis (DM), and disease-free survival (DFS) rates served as outcome measures.

Results

Compared with pT3 tongue SCC, pT4 patients presented significantly more frequently with pN2 disease, extranodal extension, poor tumor differentiation, tumor depth >15 and >20 mm, margin status ≤4 mm, perineural invasion, vascular invasion, and were more frequently treated with surgery plus concurrent chemoradiotherapy. Less favorable 5-year outcomes were observed in patients with pT4 than pT3 tumors (LRC 50 vs. 75%, p < 0.001; DM 27 vs. 14%, p = 0.013; DFS 43 vs. 69%, respectively, p < 0.001). We identified pT4 disease (vs. pT3) as an independent adverse prognostic factor for LRC and DFS.

Conclusions

We suggest classifying patients with tongue SCC and extrinsic muscle invasion as having pT4 disease.

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Acknowledgment

The authors appreciate the contribution and the valuable assistance of the Linkou Chang Gung Memorial Hospital Cancer Center databank and case managers.

Author information

Author notes

  1. Chun-Ta Liao and Li-Yu Lee contributed equally to this work.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Chun-Ta Liao MD, Chung-Jan Kang MD, Tuan-Jen Fang MD, Shiang-Fu Huang MD, PhD & Kai-Ping Chang MD, PhD

  2. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Chun-Ta Liao MD, Li-Yu Lee MD, Chuen Hsueh MD, Chien-Yu Lin MD, Kang-Hsing Fan MD, Hung-Ming Wang MD, Chia-Hsun Hsieh MD, Shu-Hang Ng MD, Chih-Hung Lin MD, Chung-Kan Tsao MD, Chung-Jan Kang MD, Tuan-Jen Fang MD, Shiang-Fu Huang MD, PhD, Kai-Ping Chang MD, PhD, Lan Yan Yang MD, PhD & Tzu-Chen Yen MD, PhD

  3. Department of Pathology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Li-Yu Lee MD & Chuen Hsueh MD

  4. Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Chien-Yu Lin MD & Kang-Hsing Fan MD

  5. Department of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Hung-Ming Wang MD & Chia-Hsun Hsieh MD

  6. Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Shu-Hang Ng MD

  7. Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Chih-Hung Lin MD & Chung-Kan Tsao MD

  8. Department of Biostatistics and Informatics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Lan Yan Yang MD, PhD

  9. Nuclear Medicine and Molecular Imaging Center, Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC

    Tzu-Chen Yen MD, PhD

Authors
  1. Chun-Ta Liao MD
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  2. Li-Yu Lee MD
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  3. Chuen Hsueh MD
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  4. Chien-Yu Lin MD
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  13. Shiang-Fu Huang MD, PhD
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  14. Kai-Ping Chang MD, PhD
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Corresponding author

Correspondence to Tzu-Chen Yen MD, PhD.

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Liao, CT., Lee, LY., Hsueh, C. et al. Clinical Outcomes in pT4 Tongue Carcinoma are Worse than in pT3 Disease: How Extrinsic Muscle Invasion Should be Considered?. Ann Surg Oncol 24, 2570–2579 (2017). https://doi.org/10.1245/s10434-017-5906-3

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  • DOI: https://doi.org/10.1245/s10434-017-5906-3

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