Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy.
Oral Oncol. 2020 Dec;111:104937. doi: 10.1016/j.oraloncology.2020.104937. Epub 2020 Aug 1.
The 8th TNM edition remarkably changed the classification of T and N categories for oral squamous cell carcinoma (OSCC). The present study aims at evaluating the improvement in prognostic power compared to the 7th edition, pros and cons of the modifications, and parameters deserving consideration for further implementations.
All OSCCs treated with upfront surgery at our institution between 2002 and 2017 were included. Demographics, clinical-pathological and treatment variables were retrieved. All tumors were classified according to both the 7th and 8th TNM edition, and patients were grouped according to the shift in T category and stage. Survivals were calculated with the Kaplan-Meier method. Univariate and multivariate analysis were carried out. Receiver Operating Characteristics (ROC) curve analyses were performed to find the best cut-off of DOI (in patients with DOI > 10 mm) and number of involved nodes (in positive neck patients).
244 patients were included. T, N categories, and stage changed in 59.2%, 20.5%, and 49.1% patients, respectively; 41.5% of patients were upstaged. The new T classification well depicted prognosis according to OS. Five-year overall (OS), disease-specific, recurrence-free (RFS) survivals were 60.5%, 70.9%, 59.8%, respectively. According to ROC curves, DOI > 20 mm and 4 positive nodes were the best cutoffs for OS and RFS.
The novelties introduced in 8th TNM edition were positive. DOI > 20 mm for T4 definition and number of positive nodes (0, <4, 4 or more) for N classification emerged as the most urgent factors to be implemented.
第 8 版 TNM 显著改变了口腔鳞状细胞癌（OSCC）的 T 和 N 分类。本研究旨在评估与第 7 版相比，其在预后能力方面的改善情况，以及这些改变的优缺点，并确定进一步实施的相关参数。
纳入我院于 2002 年至 2017 年期间行根治性手术治疗的所有 OSCC 患者。收集患者的人口统计学、临床病理学和治疗相关变量。所有肿瘤均根据第 7 版和第 8 版 TNM 进行分类，并根据 T 分期和肿瘤分期的变化进行分组。采用 Kaplan-Meier 法计算生存率。进行单因素和多因素分析。进行受试者工作特征（ROC）曲线分析，以确定 DOI（DOI>10mm 患者）和阳性淋巴结数（阳性颈部患者）的最佳截断值。
共纳入 244 例患者。T、N 分期和肿瘤分期分别有 59.2%、20.5%和 49.1%的患者发生变化，41.5%的患者被升级分期。新的 T 分类根据 OS 较好地描绘了预后。5 年总生存率（OS）、疾病特异性生存率（DFS）和无复发生存率（RFS）分别为 60.5%、70.9%和 59.8%。根据 ROC 曲线，DOI>20mm 和 4 个阳性淋巴结是 OS 和 RFS 的最佳截断值。
第 8 版 TNM 引入的新内容是积极的。T4 定义的 DOI>20mm 和 N 分类中阳性淋巴结（0、<4、4 个或更多）的数量是最需要实施的因素。
