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AJCC staging evolution and its clinical impact on resectable oral cancers: A decade-based cohort analysis
Avneet Kaur1, Rahuldeep Singh2, Afshan Afreen1
1Department of Head and Neck Oncology, Paras Health, Patna, India.
Purpose:
To assess clinical impact of American Joint Committee on Cancer (AJCC) 7th, 8th, and 9th edition transitions and staging patterns on resectable oral squamous cell carcinoma (SCC).
Methodology:
A decade-long cohort (2014-2025) was analyzed across three AJCC editions. Depth of Invasion (DOI)'s prognostic value was assessed using chi-square tests, while vermillion lip reclassification in the 9th edition was evaluated using risk ratios. Stage migration and treatment-impacting transitions were quantified using transition matrices and heatmaps. Kaplan-Meier curves with risk tables were generated to assess overall survival for the AJCC 8th and 9th editions.
Results:
Out of a sample size of 532 (M:F = 7:1; mean age 50.9 years, buccal mucosa (65%), tongue/floor of mouth (32.2%), and lip (2.8%), 96.8% were treatment-naïve. DOI-driven upstaging occurred in 29.3% of cases (McNemar's p < 0.001), prompting treatment escalation. Vermillion lip cancers demonstrated lower nodal metastatic risk than other oral subsites {RR 1.39 (95% CI: 0.47-4.11)}. Furthermore, regrouping vermillion lip within cutaneous malignancy demonstrated a 4- fold difference in propensity for nodal metastases between early and advanced T stage (RR = 4.0, 95% CI: 0.66-24.3; OR = 10.0, 95% CI: 0.94-106.5) endorsing its inclusion within cutaneous malignancy. The 7th-8th edition transition caused significant upstaging and treatment escalation, while the 9th edition remained stable except for marked lip tumor reclassification (p < 0.001). Kaplan-Meier analysis showed comparable overall survival, with a modest late advantage for the AJCC 9th edition.
Conclusion:
AJCC staging evolution has progressively improved risk stratification in oral cancers. The 8th edition introduced clinically meaningful refinements, while the 9th edition maintained staging stability and optimized lip cancer classification.
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