Pandya Kalpa, Pradeep Sivakumar, Jayakumar Naveen Kumar, Vidhyadharan Sivakumar, Hedne Naveen
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Department of Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India.
Ann Maxillofac Surg. 2021 Jan-Jun;11(1):27-31. doi: 10.4103/ams.ams_125_20. Epub 2021 Jul 24.
Inclusion of depth of invasion (DOI) and a separate classification for human papillomavirus (HPV)-associated Oropharyngeal Cancers (OPCs) are two of the many major changes in the 8 edition of the American Joint Committee on Cancer staging system. After more than 2 years of implementation, the authors found the need to evaluate if the Indian clinicians found it feasible to apply the system in their practice and if the same has influenced their decision-making.
The survey was done in the form of a questionnaire which was distributed personally and via the internet to 100 clinicians. Seventy-two clinicians responded to the questionnaire. The results were analyzed and frequency distribution was computed.
Eighty-three percent of the clinicians experienced that palpation of the tumour was not a reliable method to determine the DOI. The common issues stated by the clinicians were difficulty in assessing DOI in certain subsites of the oral cavity (most commonly retromolar trigone-83%), inability to determine DOI in patients with trismus, and inability to correlate pathological and clinical DOI. Thirteen percent of the clinicians did not rely on radiological tools for measuring the DOI. Seventy percent of the clinicians did not perform a P16 assay for patients with oropharyngeal cancers. Fifty percent of the clinicians preferred chemoradiotherapy for early HPV positive oropharyngeal cancers.
Based on the results of the survey, the authors recommend a need for more interpretative guidelines and methods for determining the DOI. The authors also emphasize the need for determining HPV status for all oropharyngeal carcinomas.
纳入浸润深度（DOI）以及对人乳头瘤病毒（HPV）相关口咽癌（OPC）进行单独分类是美国癌症联合委员会（AJCC）癌症分期系统第8版中的两项重大变化。在实施两年多后，作者发现有必要评估印度临床医生是否认为该系统在他们的实践中可行，以及这是否影响了他们的决策。
调查以问卷形式进行，问卷亲自发放并通过互联网分发给100名临床医生。72名临床医生回复了问卷。对结果进行分析并计算频率分布。
83%的临床医生认为触诊肿瘤不是确定DOI的可靠方法。临床医生指出的常见问题包括在口腔某些亚部位评估DOI困难（最常见的是磨牙后三角区，占83%）、牙关紧闭患者无法确定DOI以及无法将病理和临床DOI相关联。13%的临床医生不依赖放射学工具测量DOI。70%的临床医生未对口咽癌患者进行P16检测。50%的临床医生倾向于对早期HPV阳性口咽癌进行放化疗。
基于调查结果，作者建议需要更多关于确定DOI的解释性指南和方法。作者还强调了确定所有口咽癌HPV状态的必要性。
