Original articleComparing the eighth and the seventh editions of the American Joint Committee on Cancer staging system and the Brigham and Women's Hospital alternative staging system for cutaneous squamous cell carcinoma: Implications for clinical practice
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Patients and variables
We evaluated a retrospectively collected cohort of 186 CSCCs located in the H&N. The study included 103 male and 83 female patients with a median age of 85.5 years (range, 47-105) and a median follow-up of 79 months (range, 18.5-190.2). The data used were derived from a database of 2391 CSCCs registered from January 2008 to December 2016 at the University Hospital of Salamanca, Spain. Tumors other than those from the H&N (n = 430), recurrent tumors (n = 20), and tumors of the H&N with missing
T-stage classification using the AJCC-7, AJCC-8, and BWH staging systems
The characteristics of our cohort are described in Table I. First, the tumors were classified according to both the AJCC-7 and the AJCC-8. Some tumors were staged the same with use of both systems, but for other tumors the T stage was either upgraded or downgraded with use of the AJCC-8. Specifically, 71 of the 186 tumors (38.2%) remained in the same T stage with use of both systems, 95 tumors (51.1%) were up-staged with use of the AJCC-8, and 20 tumors (38.7%) were down-staged with use of the
Discussion
In 2010, the AJCC-7 incorporated some high-risk factors and built a completely new T stage,11 but it was found to exhibit limitations.8, 9 Recently, the AJCC-8 emerged as an upgraded classification system.2 Here, it has been shown that the AJCC-8 is better than the AJCC-7 in terms of prognosis stratification.
The vast majority of CSCC tumors associated with DSPO in the AJCC-7 were staged as T2 in our cohort, which included tumors with a heterogeneous prognosis (which is a weak point that others
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2021, Surgery (United States)Citation Excerpt :Most respondents believed that HNcSCC should not have the same pN categorization as HNmSCC owing to the distinct biological characteristics of both malignancies, that immunosuppression should be included in the staging system, and that the frequency of ENE makes it poor prognostic strati fier in HNcSCC. AJCC8 pT categories have been reported to demonstrate greater homogeneity, distinctiveness, and monotonicity compared with AJCC7.18 However, further refinement is essential to increase the utility and prognostic implications of the T stage.
Dr Moyano-Bueno and Dr Viñolas-Cuadros contributed equally to this article.
Funding sources: Dr Cañueto is partially supported by a grant (GRS 1342/A/16) from the Regional Health Office of Castile and Leon and by the program INT/M/16/17 from the Regional Health Office of Castile and Leon. Dr Pérez-Losada was partially supported by FEDER and the MICINN (grants SAF2014-56989-R and SAF2017-88854-R), the Instituto de Salud Carlos III (PIE14/00066), and the We Can Be Heroes Foundation.
Conflicts of interest: None disclosed.