Tumor thickness influences prognosis of T1 and T2 oral cavity cancer-but what thickness?

Background. Previous studies have demonstrated that tumor thickness might influence prognosis in oral cancer, but the significant point at which outcome changes has varied from 1.5 mm to 6 mm. The clinical relevance of thickness remains unclear, and a reproducible prognostic “breakpoint” needs to be...

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Published in:	Head & neck Vol. 25; no. 11; pp. 937 - 945
Main Authors:	O'Brien, Christopher J., Lauer, Christopher S., Fredricks, Susanne, Clifford, Anthony R., McNeil, Edward B., Bagia, Jai S., Koulmandas, Christina
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-11-2003 John Wiley & Sons
Subjects:	Adult Aged Aged, 80 and over Biological and medical sciences Female Humans Lymphatic Metastasis Male Medical sciences Middle Aged Mouth Neoplasms - mortality Mouth Neoplasms - pathology Multivariate Analysis oral cancer Otorhinolaryngology. Stomatology Prognosis SCC prognosis Survival Analysis tongue cancer Tongue Neoplasms - mortality Tongue Neoplasms - pathology tumor thickness Tumors Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology Human Squamous cell carcinoma Prognosis Stomatology SCC prognosis Early stage tongue cancer Malignant tumor Survival Thickness Oral cavity tumor thickness Influence Oral cavity disease Bibliographic review oral cancer
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Summary:	Background. Previous studies have demonstrated that tumor thickness might influence prognosis in oral cancer, but the significant point at which outcome changes has varied from 1.5 mm to 6 mm. The clinical relevance of thickness remains unclear, and a reproducible prognostic “breakpoint” needs to be defined. Methods. Tumor thickness was measured in 145 oral cavity squamous cancers, clinically staged T1 (n = 62) or T2 (n = 83). Clinical and pathologic data were collected prospectively between 1988 and 2000, but thickness was measured on paraffin sections for this study. Minimum follow‐up was 2 years, and thickness was correlated with local control, cervical node involvement, and survival. Patients with clinically positive nodes (n = 21) were not excluded. Overall, 55 patients had pathologic node involvement at some time in their disease. Results. Median tumor thickness was 6.2 mm, and there was little variation between sites: tongue, 6.4 mm; floor of mouth, 6.6 mm; and other sites, 5.7 mm. Median thickness for T1 tumors was 4.3 mm, significantly less than the T2 group, 8 mm (p < .01). Median thickness also varied significantly for tumors with associated nodal disease (8.5 mm) and without nodal disease (5.8 mm) (p < .01). Prognosis changed significantly at a cutoff of 4 mm with local control, nodal disease, and survival rates of 91%, 8%, and 100%, respectively, for tumors <4 mm compared with 84%, 48%, and 74% for those 4 mm or more thick (p < .01). Subgrouping greater than and less than 3 mm and 5 mm also showed a difference but with poorer discrimination. Thickness and pathologic nodal involvement were highly significant independent prognostic factors. Conclusions. Tumor thickness is a highly significant, objectively measurable prognostic factor in early stage oral cancers. There is a need to standardize techniques of measurement to allow a multiinstitutional study to be carried out. This will facilitate the development of strategies aimed at improving the outcome of higher risk patients. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000–000, 2003
Bibliography:	ark:/67375/WNG-XQGWQMVG-2 istex:B0F4CE81614C2D352B19A290B65337575A0AD2A6 ArticleID:HED10324 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1043-3074 1097-0347
DOI:	10.1002/hed.10324