Prognostic implications of the 8th Edition American Joint Committee on Cancer (AJCC) staging system in oral squamous cell carcinoma
18 April 2018 (online)
The American Joint Committee on Cancer (AJCC) has recently made two major changes in the staging system of oral squamous cell carcinoma (oSCC) in the 8th edition. One is the inclusion of depth of invasion (DOI) of the primary tumor as a modifier to the T category and second, extranodal extension (ENE) is introduced to upstage nodal positive oSCC. This study aims to evaluate the performance of the AJCC 8 staging system and compare it to its predecessor (AJCC 7).
Analysis of 663 patients with oSCC from a prospective database was performed. Multivariable analysis was performed using Cox proportional hazards competing risk model. To assess staging system performance an explained variation measure (Proportion of explained variation, PVE) and a discrimination measure (Harrell's concordance index, C-index) was used.
Within the patient group, 35.6% (N = 235) were upstaged by AJCC 8. AJCC 8 shows weak separation and limited monotonicity especially of the stage groups I to III. The estimates for model performance reveal modest predictive capacity of AJCC 8 for overall survival (OS) and disease specific survival (DSS) (Harrell's C of 0.70 and 0.74, respectively) but improved predictive capacity compared to AJCC 7 (Harrell's C of 0.69 and 0.65, respectively).
The staging system of AJCC 8 is more complex than its former version due to the inclusion of DOI and ENE. Compared to AJCC 7 it performs better in stratifying survival of oSCC patients by their stage. Nevertheless the estimates for model performance reveal still a limited utility and its applicability in daily clinical practice seems problematic.
No conflict of interest has been declared by the author(s).