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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3663–3672 | Cite as

Tumor Depth of Invasion (Tumor > 4 cm/Depth > 10 mm and Depth > 20 mm) and Through Cortex/Skin Invasion are Both Valid Criteria for Classifying Tumors as pT4a in AJCC 2018 Oral Cavity Cancer Staging System

  • Chun-Ta Liao
  • Li-Yu Lee
  • Chuen Hsueh
  • Chien-Yu Lin
  • Kang-Hsing Fan
  • Hung-Ming Wang
  • Chia-Hsun Hsieh
  • Shu-Hang Ng
  • Chih-Hung Lin
  • Chung-Kan Tsao
  • Chung-Jan Kang
  • Tuan-Jen Fang
  • Shiang-Fu Huang
  • Kai-Ping Chang
  • Li-Ang Lee
  • Ku-Hao Fang
  • Yu-Chien Wang
  • Wan-Ni Lin
  • Li-Jen Hsin
  • Lan Yan Yang
  • Tzu-Chen YenEmail author
Head and Neck Oncology
  • 140 Downloads

Abstract

Background

According to the AJCC third to seventh edition staging manuals (1988–2010), the presence of through cortex and/or skin invasion in oral cavity squamous cell carcinoma (OCSCC) identifies T4a tumors. The AJCC eighth edition (2018) introduced a depth of invasion (DOI) > 20 mm as a criterion for pT4a. Subsequently, a revision maintained that tumors > 4 cm with a DOI > 10 mm should be classified as pT4a. We sought to analyze the prognostic impact of the three distinct criteria identifying pT4a disease.

Methods

We examined 667 consecutive patients with pT3-4 buccal/gum/hard palate/retromolar SCC who underwent surgery between 1996 and 2016. pT1/pT2 (n = 108/359) disease were included for comparison purposes.

Results

The 5-year outcomes of patients with pT1/pT2/without (n = 406)/with tumor > 4 cm/DOI > 10 mm (n = 261), pT1/pT2/DOI ≤ 20 mm (n = 510)/> 20 mm (n = 157), and pT1/pT2/without (n = 305)/with through cortex/skin invasion (n = 362) were as follows: disease-specific survival (DSS), 98%/89%/79%/65%, p < 0.001, 98%/89%/78%/59%, p < 0.001, and 98%/89%79%/69%, p < 0.001; overall survival (OS), 90%/79%/63%/51%, p < 0.001, 90%/79%/63%/42%, p < 0.001, and 90%/79%/65%/52%, p < 0.001. In pT3-4 disease, a tumor > 4 cm/DOI > 10 mm was an independent adverse prognosticator for 5-year DSS rate, DOI > 20 mm was an independent adverse prognosticator for 5-year DSS and OS rates, whereas through cortex/skin invasion independently predicted 5-year OS rates.

Conclusions

All of the three criteria (tumor > 4 cm/DOI > 10 mm, DOI > 20 mm, and through cortex/skin invasion) identify high-risk patients, which should be reflected in further revisions of pT4a classification in OCSCC.

Notes

Acknowledgment

The authors appreciate the contribution and the valuable assistance of the Linkou Chang Gung Memorial Hospital Cancer Center databank and case managers. The authors also acknowledge the data management of Chen Hsiang Liao and statistical assistance provided by the Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taiwan (funded by the Ministry of Health and Welfare of Taiwan; grant MOHW107-TDU-B-212-123005).

Author Contributions

Conception and design: CTL, TCY. Analysis and interpretation of data: All authors. Drafting the article or revising it critically for important intellectual content: All authors. Final approval of manuscript: All authors. Agreement to be accountable for all aspects of the work: All authors. First authors: Chun-Ta Liao.

Disclosures

The authors have no conflicts of interest to disclose.

Supplementary material

10434_2019_7576_MOESM1_ESM.tif (1.5 mb)
Supplement Fig. 1 Proportional hazards assumption for the Cox regression models in the prediction of 5-year, disease-specific survival and overall survival in patients with pT1-4 buccal/gum/hard palate/retromolar cancer stratified according to the presence (vs. absence) of tumor > 4 cm and depth of invasion > 10 mm (A, D), depth of invasion > 20 mm (vs. ≤ 20 mm) (B, E), and presence (vs. absence) of through cortex/skin invasion (C, F) (TIFF 1503 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Chun-Ta Liao
    • 1
    • 2
  • Li-Yu Lee
    • 2
    • 3
  • Chuen Hsueh
    • 2
    • 3
  • Chien-Yu Lin
    • 2
    • 4
  • Kang-Hsing Fan
    • 2
    • 4
  • Hung-Ming Wang
    • 2
    • 5
  • Chia-Hsun Hsieh
    • 2
    • 5
  • Shu-Hang Ng
    • 2
    • 6
  • Chih-Hung Lin
    • 2
    • 7
  • Chung-Kan Tsao
    • 2
    • 7
  • Chung-Jan Kang
    • 1
    • 2
  • Tuan-Jen Fang
    • 1
    • 2
  • Shiang-Fu Huang
    • 1
    • 2
  • Kai-Ping Chang
    • 1
    • 2
  • Li-Ang Lee
    • 1
    • 2
  • Ku-Hao Fang
    • 1
    • 2
  • Yu-Chien Wang
    • 1
    • 2
  • Wan-Ni Lin
    • 1
    • 2
  • Li-Jen Hsin
    • 1
    • 2
  • Lan Yan Yang
    • 2
    • 8
  • Tzu-Chen Yen
    • 2
    • 9
    Email author
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  2. 2.Department of Head and Neck Oncology GroupLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  3. 3.Department of PathologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  4. 4.Department of Radiation OncologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  5. 5.Department of Medical OncologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  6. 6.Department of Diagnostic RadiologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  7. 7.Department of Plastic and Reconstructive SurgeryLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  8. 8.Department of Biostatistics and Informatics Unit, Clinical Trial CenterLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC
  9. 9.Department of Nuclear Medicine and Molecular Imaging Center, Gung Memorial Hospital and Chang Gung UniversityLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyüanTaiwan, ROC

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