Current Updates in Staging and Prognosis in Oral Cancer

  • Paul Covello
  • D. David KimEmail author


Purpose of review: In this update, data supporting the recent changes to the eighth edition of the AJCC staging system for oral squamous cell carcinoma, as well as other important prognostic considerations, will be presented.

Recent findings: Depth of invasion ≥4 mm and the presence of extranodal extension are independent factors that negatively impact locoregional control and survival. Computed tomography and magnetic resonance imaging have a low sensitivity, but high specificity in detecting extranodal extension. Sentinel lymph node biopsy may prove useful in oral squamous cell carcinoma with a detection rate of 98%, sensitivity of 92%, and specificity of 100%. Close resection margins of <5 mm maintain a local control rate of 91% and disease-specific survival of 84%, regardless of additional adverse tumor features. Perineural invasion, lymphovascular invasion, infiltrative patterns of invasion, and high lymph node ratios have been associated with locoregional recurrence and mortality. HPV seems to play a minor role in the oncogenesis of oral squamous cell carcinoma.

Summary: In the latest edition of the cancer staging system by the AJCC, depth of invasion and extranodal extension are used to further define staging categories. The T stage increases by one for every 5 mm of tumor DOI until ≥10 mm and the pathologic N stage increases by one with ENE. Changes better correlate to locoregional control and survival. Adverse features and tumor burden must also be considered when optimizing treatment protocols.


Oral squamous cell carcinoma (OSCC) Cancer staging Prognosis Depth of invasion Extranodal extension Extracapsular spread Resection margins Sentinel node Perineural invasion Lymphovascular invasion Human papilloma virus 



Photomicrograph in Fig. 4.2 by Ashley Flowers, MD—Assistant Professor, Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, LA.

Conflicts of interest: There are no conflicts of interest to report.


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryGeisinger HealthWilkes-BarreUSA
  2. 2.Division of Head and Neck Surgical Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial SurgeryLouisiana State University Health Sciences CenterShreveportUSA

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