Impact of Revised American Joint Committee on Cancer Staging Guidelines on Upstaging and Treatment of Oral Cavity Squamous Cell Carcinoma.

Authors

Fergal G Kavanagh, Alana Eagan, Lillian A Boe, Sean M McBride, Nancy Y Lee, Marc A Cohen, Jennifer R Cracchiolo

Published in

Journal of surgical oncology. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

In 2018, the American Joint Committee on Cancer (AJCC) updated TNM (Tumor, Nodes, Metastasis) staging for oral cavity cancers, incorporating depth of invasion into T-staging, but the impact of this change is unclear. We aimed to assess trends in upstaging and adjuvant radiation therapy use among patients with T1-3 oral cavity tumors using the National Cancer Database (NCDB).
NCDB data were analyzed on the staging and treatment of patients with T1-3 histologically confirmed squamous cell carcinoma of the oral cavity treated with surgery from 2013 to 2021. Treatment periods were defined as 2013-2017 and 2018-2021 to reflect use of the 7th and 8th editions of the AJCC staging system. Trends were analyzed using Cochran-Armitage tests, univariable/multivariable logistic regression, and Kaplan-Meier survival plots, and adjusted for sociodemographic, tumor, and hospital variables when relevant. The primary outcome was treatment modality (surgery alone vs. surgery with adjuvant therapy). The secondary outcome was change in tumor staging following the AJCC revision.
We analyzed NCDB data on the staging and treatment of 17,349 patients. The proportion of patients with pathological T1 tumors dropped from 42% to 29% between 2013 and 2017 and 2018-2021, while T3 cases rose from 5.5% to 15% (p < 0.001). The proportion of stage I tumors decreased from 26% to 17%, and stage III tumors increased from 10% to 15% (p < 0.001). Tumor size remained relatively stable. The proportion of patients treated with surgery and adjuvant radiation therapy increased from 29% to 34% (p < 0.001). The increased use of adjuvant radiation after the AJCC revision was confirmed by the Cochran-Armitage test and by multivariable logistic regression, which showed that patients diagnosed in 2018-2021 had higher odds of receiving radiation therapy (odds ratio, 1.33; p < 0.001) than those diagnosed in 2013-2017, after adjustment for covariates. Forty-eight-month overall survival did not differ between cohorts (64% in both groups).
Although the 2018 AJCC revision for oral cavity cancer staging led to significant upstaging and increased use of adjuvant radiation therapy, overall survival remained unchanged. The benefits of increased adjuvant therapy use remain unclear and warrant further investigation.

PMID:
42478345
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.

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