Despite recent advances in the diagnosis and treatment of head and neck cancer, there has been little evidence of improvement in 5‐year survival rates over the last few decades. To determine more accurate trends in site‐specific outcomes as opposed to a more general overview of head and neck cancer patients, we analyzed the site‐specific data collected in the Surveillance, Epidemiology, and End Results—SEER Public‐Use Database 1973–1999. Based on the selection criteria, 96,232 cases were evaluated for trend analysis in incidence, clinical stage, treatment and 5‐year survival. During the period 1973–1999, site‐specific incidence rates for head and neck cancer changed significantly. Site‐specific analysis of survival from 1974–1997 showed significant improvements in 5‐year survival rates for cancers of the nasopharynx, oropharynx and hypopharynx (38.1% to 56.7% for nasopharynx, p < 0.001; 36.3% to 49.1% for oropharynx, p = 0.001 and 28.3% to 33.3% for hypopharynx, p = 0.015). The prognosis for early‐stage salivary gland cancer during 1983–1997 and late‐stage larynx cancer during 1974–1997 also demonstrated improvement (82.7% to 88.5%, p = 0.012 and 22.2% to 38.3%, p = 0.013, respectively). On the other hand, the prognosis for regional stage oral cavity cancer as well as early‐stage larynx cancer patients declined during 1983–1997 (49.2% to 43.8%, p = 0.032 and 82.3% to 74.3%, p = 0.002, respectively). Site‐specific changes in treatment and staging were also noted. Site‐specific analysis allows for a more accurate description of incidence, staging, treatment, and prognostic trends for head and neck cancer.

Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification.

BACKGROUND: Malignant tumors of the skull base are rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after craniofacial surgery (CFS). The current report was based on a large cohort that was analyzed retrospectively by an International Collaborative Study Group.METHODS: One thousand three hundred seven patients who underwent CFS in 17 institutions were analyzable for outcome. The median age was 54 years (range, 1–98 years). Definitive treatment prior to CFS had been administered in 59% of patients and included radiotherapy in 367 patients (28%), chemotherapy in 151 patients (12%), and surgery in 523 patients (40%). The majority of tumors (87%) involved the anterior cranial fossa. Squamous cell carcinoma (29%) and adenocarcinoma (16%) were the most common histologic types. The margins of surgical resection were reported close/positive in 412 patients (32%). Adjuvant postoperative radiotherapy was received by 510 patients (39%), and chemotherapy was received by 57 patients (4%).RESULTS: Postoperative complications were reported in 433 patients (33%), with local wound complications the most common (18%). The postoperative mortality rate was 4%. With a median follow‐up of 25 months, the 5‐year overall, disease‐specific, and recurrence‐free survival rates were 54%, 60%, and 53%, respectively. The histology of the primary tumor, its intracranial extent, and the status of surgical margins were independent predictors of overall, disease‐specific, and recurrence‐free survival on multivariate analysis.CONCLUSIONS: CFS is a safe and effective treatment option for patients with malignant tumors of the skull base. The histology of the primary tumor, its intracranial extent, and the status of surgical margins are independent determinants of outcome. Cancer 2003;98:1179–87. © 2003 American Cancer Society.DOI 10.1002/cncr.11630

The first edition of the Manual for Staging of Cancer was published by the American Joint Committee on Cancer (AJCC) in 1977.¹ Since then, the primary tumor staging for oral squamous cell carcinoma (SCC) has remained unchanged, with the exception of refinements to the T4 classification. Although the simplicity of the current system promotes clinical utility, it is widely acknowledged that the prognostic performance is suboptimal in some patients with head and neck cancer.^2-4 This may reflect the substantial changes in management of oral SCC in the last 4 decades, based on advances in cross-sectional imaging, the introduction of positron emission tomography, the widespread use of microvascular free flap reconstruction, and significant progress in adjuvant therapy protocols. In conjunction with this evolution in management paradigms, a vast body of literature has accumulated detailing important prognostic factors in oral cancer. One such factor is the depth of invasion (DOI) of the primary tumor, which is well established as an independent predictor of recurrence and survival^5-17 and may provide information that should be integrated into the existing AJCC staging system to improve prognostic performance.