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Validation of the American Joint Committee on Cancer Staging in Squamous Cell Carcinoma of the Vermilion Lip

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

Abstract

Background

The vermilion lip is a unique anatomical junction between cutaneous and mucosal surfaces. Squamous cell carcinoma (SCC) of the vermilion lip (vlSCC) was previously classified as oral SCC (oSCC) under the American Joint Committee on Cancer (AJCC) 7th edition (AJCC7), but has been recategorized as a cutaneous SCC of the head and neck (HNcSCC) in the AJCC 8th edition (AJCC8). We investigated the locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) for the various pathological T categories and disease stages of vlSCC as per AJCC8.

Methods

We performed a retrospective cohort study of 297 patients diagnosed with vlSCC between January 2004 and February 2019. For this study, vlSCC cases were staged according to both AJCC7 and AJCC8. Kaplan–Meier survival curves and Cox regression models were used to analyze differences in LRC, DFS, and OS between each pT category and disease stage, and log-rank tests were performed for subgroup analysis.

Results

Restaging of vlSCC using the AJCC8 resulted in 19% of patients being upstaged to pT3, and 16% being upstaged to stage III. No patients were downstaged in pT stage or overall stage.

Conclusions

Our study shows that when the AJCC8 HNcSCC staging system is applied to vlSCC, there are important aberrations leading to unwarranted upstaging of pT1 and redundancy of pT2. Understanding of these limitations are important in considering treatment escalation.

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Authors and Affiliations

  1. The University of Sydney, Sydney Medical School, Sydney, NSW, Australia

    Amanda E. Yung BSc (Adv), Michael S. Que BBmed (Hons) & Angela M. Hong MBBS, MMed, PhD, FRANZCR

  2. Institute of Academic Surgery at RPA Hospital, Sydney, NSW, Australia

    Amanda E. Yung BSc (Adv), Mo Mo Tin MBBS, FRANZCR, Tsu-Hui (Hubert) Low, BSc (Med) (Hons), MBBS (Hons), FRACS, Jonathan R. Clark BSc (Med), MBBS (Hons), MBiostat FRACS & Sydney Ch’ng MBBS, PhD, FRACS

  3. Melanoma Institute of Australia, Sydney, NSW, Australia

    Serigne Lo PhD, Angela M. Hong MBBS, MMed, PhD, FRANZCR & Sydney Ch’ng MBBS, PhD, FRACS

  4. Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Shagun Aggarwal BSc (Med), MBBS (Hons), MS, FRACS & Sydney Ch’ng MBBS, PhD, FRACS

  5. Radiation Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia

    Angela M. Hong MBBS, MMed, PhD, FRANZCR

  6. Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia

    Mo Mo Tin MBBS, FRANZCR, Tsu-Hui (Hubert) Low, BSc (Med) (Hons), MBBS (Hons), FRACS, Jonathan R. Clark BSc (Med), MBBS (Hons), MBiostat FRACS & Sydney Ch’ng MBBS, PhD, FRACS

  7. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia

    Ruta Gupta MBBS, MD, FRCPA, Grad Cert in Higher Education

Authors
  1. Amanda E. Yung BSc (Adv)
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  2. Michael S. Que BBmed (Hons)
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  3. Serigne Lo PhD
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  4. Shagun Aggarwal BSc (Med), MBBS (Hons), MS, FRACS
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  5. Angela M. Hong MBBS, MMed, PhD, FRANZCR
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  6. Mo Mo Tin MBBS, FRANZCR, Tsu-Hui (Hubert) Low, BSc (Med) (Hons), MBBS (Hons), FRACS
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  7. Jonathan R. Clark BSc (Med), MBBS (Hons), MBiostat FRACS
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  8. Ruta Gupta MBBS, MD, FRCPA, Grad Cert in Higher Education
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  9. Sydney Ch’ng MBBS, PhD, FRACS
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Contributions

AEYung: Data curation, formal analysis, writing—original draft; MSQ: Data curation; SL: Formal analysis; SA: Writing—review and editing; AMH: Writing—review and editing; MMT: Writing—review and editing; T-H (Hubert) Low: Writing—review and editing; JRC: Writing—review and editing; RG: Data curation, writing—review and editing; SC: Conceptualization, writing—original draft, supervision.

Corresponding author

Correspondence to Sydney Ch’ng MBBS, PhD, FRACS.

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Yung, A.E., Que, M.S., Lo, S. et al. Validation of the American Joint Committee on Cancer Staging in Squamous Cell Carcinoma of the Vermilion Lip. Ann Surg Oncol 28, 3092–3099 (2021). https://doi.org/10.1245/s10434-020-09431-4

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  • DOI: https://doi.org/10.1245/s10434-020-09431-4

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