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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

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

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.

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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. 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).

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Authors and Affiliations

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

    Chun-Ta Liao MD, Chung-Jan Kang MD, Tuan-Jen Fang MD, Shiang-Fu Huang MD, Kai-Ping Chang MD, Li-Ang Lee MD, Ku-Hao Fang MD, Yu-Chien Wang MD, Wan-Ni Lin MD & Li-Jen Hsin MD

  2. Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyüan, 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, Kai-Ping Chang MD, Li-Ang Lee MD, Ku-Hao Fang MD, Yu-Chien Wang MD, Wan-Ni Lin MD, Li-Jen Hsin MD, Lan Yan Yang PhD & Tzu-Chen Yen MD

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

    Li-Yu Lee MD & Chuen Hsueh MD

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

    Chien-Yu Lin MD & Kang-Hsing Fan MD

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

    Hung-Ming Wang MD & Chia-Hsun Hsieh MD

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

    Shu-Hang Ng MD

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

    Lan Yan Yang PhD

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

    Tzu-Chen Yen MD

Authors
  1. Chun-Ta Liao MD
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  2. Li-Yu Lee MD
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  4. Chien-Yu Lin MD
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  7. Chia-Hsun Hsieh MD
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  11. Chung-Jan Kang MD
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  12. Tuan-Jen Fang MD
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  13. Shiang-Fu Huang MD
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  14. Kai-Ping Chang MD
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  15. Li-Ang Lee MD
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  16. Ku-Hao Fang MD
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  17. Yu-Chien Wang MD
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  18. Wan-Ni Lin MD
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  19. Li-Jen Hsin MD
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  20. Lan Yan Yang PhD
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  21. Tzu-Chen Yen MD
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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.

Corresponding author

Correspondence to Tzu-Chen Yen MD.

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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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Liao, CT., Lee, LY., Hsueh, C. et al. 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. Ann Surg Oncol 26, 3663–3672 (2019). https://doi.org/10.1245/s10434-019-07576-5

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