Real-world multicenter evaluation of the AJCC TNM-9 staging for oral minor salivary gland carcinomas
4 affiliations
- 1Department of Stomatology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People’s Hospital), Zhengzhou, 450003 PR China
- 2Department of Stomatology, Henan People’s Hospital, Zhengzhou, 450001 PR China
- 3Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001 PR China
- 4Department of Head Neck, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008 PR China
Abstract
Background: The 8th edition AJCC TNM (TNM-8) staging framework frequently lacks distinct prognostic discrimination for minor salivary gland carcinomas (mSGCs). This multicenter study was designed to validate the proposed 9th edition (TNM-9) classification, which is tailored to better reflect the biology of these tumors, specifically in oral mSGCs.
Methods: We conducted a retrospective cohort study encompassing 163 patients with primary oral mSGCs treated with curative intent across four tertiary cancer centers. All cases were re-staged using both TNM-8 and the proposed TNM-9 criteria. The primary endpoint was disease-specific survival (DSS). System performance was compared using the Harrell C-index, Akaike Information Criterion (AIC), categorical Net Reclassification Improvement (NRI), and Decision Curve Analysis.
Results: Under the TNM-9 system, survival curves for DSS showed clear and statistically significant separation across all stage groups (p < 0.001). In contrast, TNM-8 failed to significantly differentiate between Stage III and Stage IV outcomes. Advanced TNM-9 stages (IIIA and IIIB) were strong independent predictors of worse DSS. TNM-9 demonstrated superior discriminative ability compared to TNM-8 (C-index: 0.74 vs. 0.68) and a better model fit (AIC: 460 vs. 485). Additionally, TNM-9 correctly reclassified 23% of patients (NRI = 0.23; p = 0.002) and yielded consistently higher clinical net benefit.
Conclusion: The proposed TNM-9 classification showed better prognostic discrimination, model fit, and risk reclassification than TNM-8 within this retrospective multicenter cohort. External validation of TNM-9 in larger, geographically diverse cohorts with longer follow-up is required before its routine clinical adoption.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09176-8.
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BibTeX
@article{li2026realworld,
title = {{Real-world multicenter evaluation of the AJCC TNM-9 staging for oral minor salivary gland carcinomas}},
author = {Fang Li and Shuang Hu and Bingran Du and Hongli Chen and Wenlu Li and Liyuan Dai and Qigen Fang},
journal = {BMC Oral Health},
year = {2026},
month = jul,
doi = {10.1186/s12903-026-09176-8},
url = {https://doi.org/10.1186/s12903-026-09176-8},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Real-world multicenter evaluation of the AJCC TNM-9 staging for oral minor salivary gland carcinomas
AU - Fang Li
AU - Shuang Hu
AU - Bingran Du
AU - Hongli Chen
AU - Wenlu Li
AU - Liyuan Dai
AU - Qigen Fang
PY - 2026
DA - 2026/07/31
JO - BMC Oral Health
DO - 10.1186/s12903-026-09176-8
UR - https://doi.org/10.1186/s12903-026-09176-8
AB - Background: The 8th edition AJCC TNM (TNM-8) staging framework frequently lacks distinct prognostic discrimination for minor salivary gland carcinomas (mSGCs). This multicenter study was designed to validate the proposed 9th edition (TNM-9) classification, which is tailored to better reflect the biology of these tumors, specifically in oral mSGCs. Methods: We conducted a retrospective cohort study encompassing 163 patients with primary oral mSGCs treated with curative intent across four tertiary cancer centers. All cases were re-staged using both TNM-8 and the proposed TNM-9 criteria. The primary endpoint was disease-specific survival (DSS). System performance was compared using the Harrell C-index, Akaike Information Criterion (AIC), categorical Net Reclassification Improvement (NRI), and Decision Curve Analysis. Results: Under the TNM-9 system, survival curves for DSS showed clear and statistically significant separation across all stage groups (p < 0.001). In contrast, TNM-8 failed to significantly differentiate between Stage III and Stage IV outcomes. Advanced TNM-9 stages (IIIA and IIIB) were strong independent predictors of worse DSS. TNM-9 demonstrated superior discriminative ability compared to TNM-8 (C-index: 0.74 vs. 0.68) and a better model fit (AIC: 460 vs. 485). Additionally, TNM-9 correctly reclassified 23% of patients (NRI = 0.23; p = 0.002) and yielded consistently higher clinical net benefit. Conclusion: The proposed TNM-9 classification showed better prognostic discrimination, model fit, and risk reclassification than TNM-8 within this retrospective multicenter cohort. External validation of TNM-9 in larger, geographically diverse cohorts with longer follow-up is required before its routine clinical adoption. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09176-8.
SN - 1472-6831
ER -