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TNM 8 staging is a better prognosticator than TNM 7 for patients with locally advanced oral cavity squamous cell carcinoma treated with surgery and post-operative radiotherapy

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K Sambasivan, I Sassoon, S Thavaraj, R Kennedy, G Doss, A Michaelidou, E Odell, A Sandison, G Hall, P Morgan, L H C Collins, A Lyons, L Cascarini, A Fry, R Oakley, R Simo, J P Jeannon, I Petkar, M Reis Ferreira, A Kong & 2 more Mary Lei, T Guerrero Urbano

Original languageEnglish
Pages (from-to)54-60
Number of pages7
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume160
Early online date9 Apr 2021
DOIs
E-pub ahead of print9 Apr 2021
PublishedJul 2021

Bibliographical note

Funding Information: Dr R Kennedy is funded by the National Institute for Health Research (NIHR) (Academic Clinical Lectureship) for this research project. This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England. Publisher Copyright: © 2021 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

PURPOSE: To assess TNM 8 staging in discriminating overall survival (OS) amongst patients with locally advanced oral cavity squamous cell carcinoma (OCSCC) treated with surgery and post-operative radiotherapy (PORT), compared to TNM 7.

MATERIAL AND METHODS: Data from OCSCC patients treated with surgery and PORT between January 2010 and December 2018 were reviewed. Demographics, tumour characteristics and treatment response data were collected, and patients staged according to both TNM 7 and TNM 8. OS and disease free survival (DFS) were estimated using the Kaplan Meier method. Univariate and multivariable analyses were conducted for factors affecting OS, DFS and early disease recurrence within 12 months.

RESULTS: Overall 172 patients were analyzed. Median follow up was 32 months for all patients and 48 months for surviving patients. TNM 8 staging demonstrated significant stratification of OS and DFS amongst the entire cohort, whereas TNM 7 staging did not. On multivariable analysis, TNM 8 stage, performance status (PS) and a positive surgical margin were prognostic for OS. Looking at disease recurrence within 12 months, TNM 8 stage IVB, presence of lymphovascular invasion (LVSI), younger age and lesser smoking history were predictive factors on multivariable analysis.

CONCLUSION: TNM 8 is a good development of its predecessor in terms of predicting survival for patients with locally advanced OCSCC. We have also identified younger age (<60 years) and a smoking history of <10 pack years as risk factors for early disease recurrence, potentially representing a separate biological cohort within OCSCC patients.

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