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Program Number: B204
Session Name: Poster Session

Impact of AJCC 8th Edition Staging Guidelines on the Upstaging and Treatment of Oral Cavity Squamous Cell Carcinoma

Fergal Kavanagh, MD, PhD; Alana Egan; Lily Boe; Marc Cohen; Jennifer Cracchiolo, MD; Memorial Sloan Kettering Cancer Center

Introduction: In 2018, the American Joint Committee on Cancer (AJCC) updated TNM staging for oral cavity cancers, incorporating depth of invasion into T-staging causing notable tumor upstaging. This study sought to assess treatment trends of adjuvant therapy for T1-3 oral cavity tumors on a national scale utilizing the National Cancer Database (NCDB).

Methods: Patients diagnosed with T1-T3 histologically confirmed squamous cell carcinoma of the oral cavity treated with surgery from 2013 to 2021 in the NCDB were analyzed. Cohorts were divided by AJCC 7th edition (2013-2017) and AJCC 8th edition (2018-2021). We examined adjuvant therapy rates over time periods according to sociodemographic, tumor and hospital variables. Trends were analyzed using Cochran-Armitage tests, univariable/multivariable logistic regression for associations, and Kaplan-Meier plots for survival.

Results: Analysis included 21,024 patients. Tumor upstaging was evident: pathological T1 cases dropped from 37% (2013-2017) to 25% (2018-2021), while T3 cases rose from 7% (2013-2017) to 16% (2018-2021) (p<0.001). Stage I tumors decreased from 21% to 14%, while stage III increased from 10% to 14% in the same periods (p<0.001). Although upstaging was observed, tumor size remained constant; however, coding changes limited full statistical analysis. Surgery alone was performed in 58% of cases (2013-2017) compared to 55% (2018-2021) (p < 0.001). Surgery with adjuvant RT increased from 24% (2013-2017) to 28% (2018-2021) (p<0.001). Cochran-Armitage test showed a trend towards an increase in the use of surgery and adjuvant RT after the AJCC staging was updated (see figure 1). Multivariable logistic regression showed that patients diagnosed after 2018 had lower odds (OR = 0.84; p < 0.001) of receiving surgery alone compared to those diagnosed from 2013-2017, after adjusting for age, tumor size, and lymphovascular invasion. The 48-month survival rates were 64% for the 2013-2018 cohort (95% CI: 63%-65%) and 2018-2021 cohort (95% CI: 62%-65%) (p 0.2)

Conclusion: The 2018 AJCC revision for oral cavity cancer staging led to significant upstaging, with fewer T1 and stage I cases and more T3, stage III cases. This shift led to increased uses of adjuvant radiation therapy. Despite treatment escalation from upstaging, OS remained unchanged. The benefits of increased adjuvant therapy use remain unclear and warrant further analysis as data matures.

 

 

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