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Patel AM, Vedula S, Shaari AL, Choudhry HS, Filimonov A. Extranodal extension in laryngeal squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2024; 9:e1232. [PMID: 38529341 PMCID: PMC10961995 DOI: 10.1002/lio2.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/11/2024] [Indexed: 03/27/2024] Open
Abstract
Objective Although large retrospective database studies have associated extranodal extension (ENE) with worse survival in several head and neck cancers, the prognostic significance of ENE in laryngeal squamous cell carcinoma (LSCC) remains unclear. Our study examines ENE and overall survival (OS) in LSCC. Methods The 2006-2017 National Cancer Database was queried for patients with LSCC undergoing surgical resection and neck dissection, with or without adjuvant therapy. Kaplan-Meier and multivariable Cox regression survival analyses were implemented to identify the independent impacts of pathologic nodal (pN) classification and ENE on OS. Results Of 4208 patients satisfying inclusion criteria, 2343 (55.7%) were pN0/ENE-negative, 1059 (25.2%) were pN1-2/ENE-negative, and 806 (19.2%) were pN1-2/ENE-positive. The 5-year OS of pN0/ENE-negative, pN1-2/ENE-negative, and pN1-2/ENE-positive patients was 62.8%, 56.7%, and 32.9%, respectively (p < .001). Among pN1-2/ENE-positive patients undergoing no adjuvant therapy, adjuvant radiotherapy alone, and adjuvant chemoradiotherapy, 5-year OS was 24.1%, 30.7%, and 36.7%, respectively (p < .001). After adjusting for patient demographics, clinicopathologic features, and adjuvant therapy, ENE-positivity was associated with worse OS than ENE-negativity (adjusted hazard ratio [aHR] 1.76, 95% confidence interval [CI] 1.53-2.02, p < .001). pN1/ENE-positivity (aHR 1.82, 95% CI 1.31-2.54) and pN2/ENE-positivity (aHR 1.89, 95% CI 1.49-2.40) were associated with worse OS than pN1/ENE-negativity (p < .001). Microscopic (aHR 1.83, 95% CI 1.54-2.18) and macroscopic ENE-positivity (aHR 1.75, 95% 1.35-2.26) were associated with worse OS than ENE-negativity (p < .001). Conclusion ENE-positivity has prognostic significance in LSCC and is associated with worse OS than ENE-negativity. pN classification did not have prognostic significance independent of ENE. ENE should be carefully considered when determining the prognosis of LSCC and selecting adjuvant therapy. Level of Evidence 4.
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Affiliation(s)
- Aman M. Patel
- Department of Otolaryngology—Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Sudeepti Vedula
- Department of Otolaryngology—Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Ariana L. Shaari
- Department of Otolaryngology—Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Hannaan S. Choudhry
- Department of Otolaryngology—Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Andrey Filimonov
- Department of Otolaryngology—Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
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Kaltoft M, Hahn CH, Wessman M, Hansen ML, Agander TK, Makouei F, Wessel I, Todsen T. Intraoral Ultrasound versus MRI for Depth of Invasion Measurement in Oral Tongue Squamous Cell Carcinoma: A Prospective Diagnostic Accuracy Study. Cancers (Basel) 2024; 16:637. [PMID: 38339388 PMCID: PMC10854529 DOI: 10.3390/cancers16030637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) of the tongue is the most common type of oral cavity cancer, and tumor depth of invasion (DOI) is an important prognostic factor. In this study, we investigated the accuracy of intraoral ultrasound and magnetic resonance imaging (MRI) for assessing DOI in patients with OSCC. Histopathological measurement of DOI was used as a reference standard. We conducted a prospective study including patients planned for surgical treatment of OSCC in the tongue. The DOI was measured in an outpatient setting by intraoral ultrasound and MRI, and was compared to the histopathological DOI measurements. Bland-Altman analysis compared the mean difference and 95% limits of agreement (LOA) for ultrasound and MRI, and the Wilcoxon signed-rank test was used to test for significance. The correlation was evaluated using Pearson's correlation coefficient. We included 30 patients: 26 with T1 or T2 tumors, and 4 with T3 tumors. The mean difference from histopathology DOI was significantly lower for ultrasound compared to MRI (0.95 mm [95% LOA -4.15 mm to 6.06 mm] vs. 1.90 mm [95% LOA -9.02 mm and 12.81 mm], p = 0.023). Ultrasound also led to significantly more correct T-stage classifications in 86.7% (26) of patients compared to 56.7% (17) for MRI, p = 0.015. The Pearson correlation between MRI and histopathology was 0.57 (p < 0.001) and the correlation between ultrasound and histopathology was 0.86 (p < 0.001). This prospective study found that intraoral ultrasound is more accurate than MRI in assessing DOI and for the T-staging of oral tongue cancers. Clinical practice and guidelines should implement intraoral ultrasound accordingly.
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Affiliation(s)
- Mikkel Kaltoft
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
| | - Christoffer Holst Hahn
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Marcus Wessman
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
| | - Martin Lundsgaard Hansen
- Department of Radiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Tina Klitmøller Agander
- Department of Pathology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Fatemeh Makouei
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Irene Wessel
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Capital Region, 2100 Copenhagen, Denmark
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3
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Kowalski LP. Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery. Int Arch Otorhinolaryngol 2023; 27:e536-e546. [PMID: 37564472 PMCID: PMC10411134 DOI: 10.1055/s-0043-1761170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors-including treatment, decision-making, and quality-can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.
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Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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4
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Banerjee A, Wati SM, Rahayu RP. Real Scenario of Oral Cancer Awareness Sessions-A Narrative Viewpoint. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S783-S785. [PMID: 37654418 PMCID: PMC10466580 DOI: 10.4103/jpbs.jpbs_607_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 09/02/2023] Open
Abstract
Oral cancer is one of the most common forms of cancer seen in Southeast Asia. Tobacco, betel nut, and slaked lime are the important constituents of betel quid; this is regularly consumed by the youth and elderly as their regular practice. To curb this oral cancer menace, there are numerous policies and pathways, which are adopted by government, local authorities, and institutions. Among the various policies, one of the easiest ways to reach out to masses is in form of screening camps and sessions. Oral cancer screening forms the most vital part of any dental check-up camps. Due to ignorance or lack of adequate knowledge about the deadly results of cancer, people often neglect these screening camps. This may attribute to various reasons that lead to such ignorance and failure of such free screening sessions.
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Affiliation(s)
- Abhishek Banerjee
- Associate Professor and PG Guide, Department of Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
- Oral and Maxillofacial Pathology, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Sisca M. Wati
- Oral and Maxillofacial Pathology, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Retno P. Rahayu
- Oral and Maxillofacial Pathology, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
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5
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Mahajan A, Agarwal U, PG N, Vaish R, Shukla S, Sahu A, Bhalla AS, Patil V, Ankathi SK, Laskar SG, Patil V, Noronha V, Menon N, Prabhash K, Shah D, Patil A, Ahuja A, Chaturvedi P, Pai PS, Dcruz AK. Imaging Recommendations for Diagnosis, Staging, and Management of Oral Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
AbstractOral cavity cancers contribute to a majority of cancers in India. Clinical examination alone cannot determine the deeper extent of the disease; therefore, need for cross-sectional imaging including computed tomography and magnetic resonance imaging becomes indispensable for pre-treatment evaluation to decide optimal plan of management. Oral cavity squamous cell cancers (OSCC) can be treated with surgery alone, whereas deep muscle, neurovascular, osseous, or nodal involvement on imaging suggests advanced disease that requires a combination of surgery, radiation, and/or chemotherapy. Because of the complex anatomy of the oral cavity and its surrounding structures, imaging is crucial for locoregional staging and early detection of distant metastases. Imaging plays indispensable role not only in diagnosis but also in planning the management. An optimal guideline paper for developing countries like India is lacking that not only helps standardize the management but will also assist oncologists make reasonable decisions and reduce the unnecessary imaging. This imaging guideline paper will discuss the optimal imaging in diagnosis and management OSCC for Indian subcontinent.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, The Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nandakumar PG
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Richa Vaish
- Department of Head and Neck Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shreya Shukla
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vasundhara Patil
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Suman Kumar Ankathi
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Diva Shah
- Department of Radiodiagnosis, HCG Cancer Centre, Vadodara, Gujarat, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ankita Ahuja
- Department of Radiodiagnosis, Innovision Imaging, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh S. Pai
- Department of Head and Neck Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A K Dcruz
- Apollo Hospitals, Belapur, Mumbai, India
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6
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Baba A, Kurokawa R, Kurokawa M, McHugh JB, Hines C, Ota Y, Srinivasan A. The relationship between contrast-enhanced computed tomography features of hard palate cancer and pathologic depth of invasion. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:649-657. [DOI: 10.1016/j.oooo.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
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7
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Mahajan A, Agarwal U, Patil V, Patil V, Vaish R, Noronha V, D' Cruz A, Pankaj Chaturvedi S, Laskar S, Sable N, Janu A, Patil A, Rane S, Mittal N, Joshi A, Menon N, Prabhash K. Proposed sub-compartmentalization of high infratemporal fossa involvement in gingivobuccal cancers and its impact on clinical outcome and staging: A narrative review. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_293_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Saidak Z, Lailler C, Testelin S, Chauffert B, Clatot F, Galmiche A. Contribution of Genomics to the Surgical Management and Study of Oral Cancer. Ann Surg Oncol 2021; 28:5842-5854. [PMID: 33846893 PMCID: PMC8460589 DOI: 10.1245/s10434-021-09904-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
Background Oral squamous cell carcinoma (OSCC) is the most frequent type of tumor arising from the oral cavity. Surgery is the cornerstone of the treatment of these cancers. Tumor biology has long been overlooked as an important contributor to the outcome of surgical procedures, but recent studies are challenging this concept. Molecular analyses of tumor DNA or RNA provide a rich source of information about the biology of OSCC. Methods We searched for relevant articles using PubMed. We examined in particular the prospect of applying molecular methods for minimally invasive exploration of OSCC biology. Results We examined five potential applications of genomics to the surgical management and study of OSCC: i) assessing oral potentially malignant lesions; ii) tumor staging prior to surgery; iii) predicting postoperative risk in locally advanced tumors; iv) measuring minimal residual disease and optimizing the longitudinal monitoring of OSCC; and v) predicting the efficacy of medical treatment. Conclusions Genomic information can be harnessed in order to identify new biomarkers that could improve the staging, choice of therapy and management of OSCC. The identification of new biomarkers is awaited for better personalization of the surgical treatment of OSCC.
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Affiliation(s)
- Zuzana Saidak
- UR7516 "CHIMERE, Université de Picardie Jules Verne", Amiens, France. .,Centre de Biologie Humaine, CHU Amiens, Amiens, France.
| | - Claire Lailler
- UR7516 "CHIMERE, Université de Picardie Jules Verne", Amiens, France.,Centre de Biologie Humaine, CHU Amiens, Amiens, France
| | - Sylvie Testelin
- UR7516 "CHIMERE, Université de Picardie Jules Verne", Amiens, France.,Department of Maxillofacial Surgery, CHU Amiens, Amiens, France
| | - Bruno Chauffert
- UR7516 "CHIMERE, Université de Picardie Jules Verne", Amiens, France.,Department of Oncology, CHU Amiens, Amiens, France
| | - Florian Clatot
- Centre Henri Becquerel, Rouen, France.,INSERM U1245/Team IRON, Rouen, France
| | - Antoine Galmiche
- UR7516 "CHIMERE, Université de Picardie Jules Verne", Amiens, France.,Centre de Biologie Humaine, CHU Amiens, Amiens, France
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Chakrabarti D, Akhtar N, Qayoom S, Rajan S, Kumar V, Gupta R, Chaturvedi A. Optimising elective neck dissection for early oral cancers. Oral Oncol 2020; 114:105090. [PMID: 33199173 DOI: 10.1016/j.oraloncology.2020.105090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India.
| | - Sumaira Qayoom
- Department of Pathology, King George's Medical University, Lucknow, India
| | - Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Rajeev Gupta
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
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Subash A, Sinha P, Singh A. Revisiting the role of depth of invasion in clinical TNM staging. Oral Oncol 2020; 109:104680. [PMID: 32273153 DOI: 10.1016/j.oraloncology.2020.104680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
AJCC 8th Edition of Cancer Staging Manual has now incorporated depth of invasion (DOI) into the clinical staging of oral cavity carcinoma. This inclusion finds relevance as it opens the concept of 3rd dimension in clinical staging. Though a very thoughtful and necessary addendum into the cancer staging, its relevance and prognostic role has been challenged by recent studies. However, there is ambiguity on clinical evaluation of DOI, which has been undermining its relevance in clinical staging. We believe that the subsequent changes to the clinical staging should relook at the concept of 3rd dimension and not DOI for better reliability and acceptance.
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Affiliation(s)
- Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bangalore, India.
| | - Piyush Sinha
- Department of Head and Neck Surgical Oncology, Medanta Hospital, Lucknow, India
| | - Abhijeet Singh
- Department of Surgical Oncology, AIIMS, Hrishikesh, India
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