Tumor thickness versus depth of invasion

analysis of the 8th edition American Joint Committee on Cancer Staging for oral cancer

Richard Dirven*, Ardalan Ebrahimi, Nikolaus Moeckelmann, Carsten Erich Palme, Ruta Gupta, Jonathan Clark

*Corresponding author for this work

Research output: Contribution to journalArticle

44 Citations (Scopus)


Objectives: The primary aim of this study is to compare the effect of using tumor thickness versus depth of invasion (DOI) to determine the 8th edition AJCC T-category on survival in a large cohort of OSCC. Materials and methods: A retrospective cohort study of patients whose clinicopathologic information had been collected prospectively into a dedicated head and neck database. 927 patients with oral SCC were identified in this cohort, with the final study population including 456 patients with complete information on DOI, tumor thickness, T and N staging and follow-up. Results: 26 (5.7%) patients had a different AJCC 8 T category when using thickness instead of depth. 15 were upstaged from T1 to T2, 10 upstaged from T2 to T3 and 1 down staged from T2 to T1. Additionally, similar stratification of disease-specific and overall survival curves were found for T category based on DOI and thickness. Conclusion: The T category and TNM stage prognostic performance of 8th edition AJCC staging of oral cancer is similar regardless of whether DOI or thickness is used as the T-category modifier. In centers without complete DOI data it is reasonable to impute thickness for retrospective survival analyses using the 8th edition of the AJCC staging system.

Original languageEnglish
Pages (from-to)30-33
Number of pages4
JournalOral Oncology
Publication statusPublished - 1 Nov 2017


  • AJCC 8
  • Depth of invasion (DOI)
  • Disease-specific survival
  • Oral SCC
  • Overall survival
  • Staging
  • T category
  • Thickness

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