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. 2023 Jan;280(1):339-346.
doi: 10.1007/s00405-022-07561-x. Epub 2022 Aug 1.

Need for adjuvant radiotherapy in oral cancer: depth of invasion rather than tumor diameter

Cosima E Riemenschnitter  1 , Grégoire B Morand  2 , Charlotte S Schouten  2 , Niels J Rupp  3 , Panagiotis Balermpas  4 , Thomas Gander  5 , Martina A Broglie Däppen  2
Affiliations

Need for adjuvant radiotherapy in oral cancer: depth of invasion rather than tumor diameter

Cosima E Riemenschnitter et al. Eur Arch Otorhinolaryngol. 2023 Jan.

Abstract

Purpose: The 8th edition of the TNM Cancer Staging Manual incorporates depth of invasion (DOI) into the pathologic tumor classification for oral squamous cell carcinoma (OSSC). While deep invading tumors with small tumor diameters (TD) have been categorized as early stage tumors in the 7th edition, they are now upstaged, potentially influencing the decision to initiate adjuvant radiotherapy (RT).

Methods: OSCC patients surgically treated with curative intent between 2010 and 2019 were consecutively included. Tumors were staged based on TD only (according to the 7th edition TNM Cancer Staging Manual), then restaged based solely on DOI.

Results: Of the 133 included patients, 58 patients (43.6%) had a different pT-stage when using DOI instead of TD for staging (upstaging in 23.3%). Overall survival (OS) was significantly worse in patients who were upstaged with DOI. In addition, stratification by adjuvant RT showed significant worse OS in upstaged patients without receiving adjuvant RT.

Conclusions: DOI seems to be an import indicator for adjuvant RT in OSCC-patients.

Keywords: Carcinoma, squamous cell; Mouth neoplasms; Neoplasm recurrence, local; Neoplasm staging; Otolaryngology; Radiotherapy, adjuvant.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Depth of invasion and tumor diameter measurements as used in the AJCC 8th edition guidelines and the College of American Pathologists
Fig. 2
Fig. 2
Overview of the distribution across pT-stages for the 7th edition (a) and for the reduced 8th edition (b)
Fig. 3
Fig. 3
Bar chart shows the four pT-stage groups according to TD on the horizontal axis, divided into the pT-stages after restaging according to DOI. The bars highlighted in red correspond to the group of patients who retained the same pT after restaging (TD→DOI)
Fig. 4
Fig. 4
Kaplan–Meier analysis showing significant differences in overall survival when dividing the cases in three groups: equally staged vs down staged vs upstaged after reclassification from 7th TNM edition to DOI only (Panel A, log-rank, p = 0.014). Then the group of patients with adjuvant treatment was compared with those without postoperative radio(chemo)therapy. The overall survival of the upstaged group without adjuvant RT was significantly worse (Panel B, log-rank, p = 0.369; Panel C, log-rank, p = 0.017)
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