University of Oulu

Almangush, A., Mäkitie, A.A., Mäkinen, L.K. et al. Virchows Arch (2018) 473: 481.

Small oral tongue cancers (≤ 4 cm in diameter) with clinically negative neck : from the 7th to the 8th edition of the American Joint Committee on Cancer

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Author: Almangush, Alhadi1,2,3; Mäkitie, Antti A.4,5; Mäkinen, Laura K.4;
Organizations: 1Department of Pathology, University of Helsinki, Haartmaninkatu 3 (P.O. Box 21), FIN-00014 Helsinki, Finland
2Department of Pathology, University of Turku, Turku, Finland
3Institute of Dentistry, University of Misurata, Misurata, Libya
4Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
5Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
6Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
7Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
8Department of Otorhinolaryngology and Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland
9HUSLAB, Department of Pathology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
10Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
11Department of Otorhinolaryngology and Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
12Department of Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
13Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, -SP, Brazil
14Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
15Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
16Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, São Paulo, Brazil
17Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: Springer Nature, 2018
Publish Date: 2019-07-23


One of the main changes in the 8th edition of the American Joint Committee on Cancer (AJCC) for staging of oral cancer is the inclusion of depth of invasion (DOI) in the T category. However, cancers in different oral subsites have variable behavior, with oral tongue squamous cell carcinoma (OTSCC) being the most aggressive one even at early stage. Thus, it is necessary to evaluate the performance of this new T category in homogenous cohort of early OTSCC. Therefore, we analyzed a large cohort of patients with a small (≤ 4 cm) OTSCC to demonstrate the differences in T stage between the AJCC 7th and 8th editions. A total of 311 early-stage cases (AJCC 7th) of OTSCC were analyzed. We used 5 mm and 10 mm DOI for upstaging from T1 to T2 and from T2 to T3 respectively, as in the AJCC 8th. We further reclassified the cases according to our own proposal suggesting 2 mm to upstage to T2 and 4 mm to upstage to T3. According to AJCC 7th, there were no significant differences in the survival analysis. When we applied the 8th edition, many cases were upstaged to T3 and thus associated with worse disease-specific survival (HR 2.37, 95% CI 1.12–4.99) and disease-free survival (HR 2.12, 95% CI 1.09–4.08). Based on our proposal, T3 cases were associated with even worse disease-specific survival (HR 4.19, 95% CI 2.27–7.74). The 8th edition provides better survival prediction for OTSCC than the 7th and can be further optimized by lowering the DOI cutoffs.

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Series: Virchows Archiv. European journal of pathology
ISSN: 0945-6317
ISSN-E: 1432-2307
ISSN-L: 0945-6317
Volume: 473
Issue: 4
Pages: 481 - 487
DOI: 10.1007/s00428-018-2417-y
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3125 Otorhinolaryngology, ophthalmology
3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study received funding from the Finnish Dental Society, the Rauha Ahokas Foundation, K. Albin Johanssons Foundation, the Helsinki University Hospital Research Fund, the Sigrid Juselius Foundation, the Finnish Cancer Society, Finska Läkaresällskapet, and the Maritza and Reino Salonen Foundation.
Copyright information: © Springer-Verlag GmbH Germany, part of Springer Nature 2018. This is a post-peer-review, pre-copyedit version of an article published in Virchows Archiv. The final authenticated version is available online at: