{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:16:30Z","timestamp":1788401790739,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,10,19]],"date-time":"2016-10-19T00:00:00Z","timestamp":1476835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24593027"],"award-info":[{"award-number":["24593027"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A multi\u2010institutional study was undertaken to determine whether mandibular canal (<jats:styled-content style=\"fixed-case\">MC<\/jats:styled-content>) invasion and mandibular medullary bone invasion are independent factors in lower gingival squamous cell carcinoma (<jats:styled-content style=\"fixed-case\">SCC<\/jats:styled-content>). A total of 345 patients with lower gingival <jats:styled-content style=\"fixed-case\">SCC<\/jats:styled-content> were retrospectively reviewed. Mandibular bone invasion was categorized into three types; no bone invasion; invasion through cortical bone (medullary); and <jats:styled-content style=\"fixed-case\">MC<\/jats:styled-content> invasion. The overall survival rate and factors affecting local, regional, and distant failures were assessed by Cox proportional hazards regression analysis and Kaplan\u2013Meier estimates. Bone invasion was present in 201 (58%) patients, of whom 107 (31%) had medullary invasion and 94 (27%) had <jats:styled-content style=\"fixed-case\">MC<\/jats:styled-content> invasion. Using the International Union Against Cancer (<jats:styled-content style=\"fixed-case\">UICC<\/jats:styled-content>) staging system and American Joint Committee on Cancer (<jats:styled-content style=\"fixed-case\">AJCC<\/jats:styled-content>) system, 171 (50%) patients were classified as T4a. When the bone invasion criteria were excluded from the <jats:styled-content style=\"fixed-case\">UICC<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">AJCC<\/jats:styled-content> system definition, 152 T4a tumors were downstaged and reclassified to T1 in 12 (3%), to T2 in 98 (28%), and to T3 in 42 (12%). In Cox multivariate analysis, <jats:styled-content style=\"fixed-case\">MC<\/jats:styled-content> invasion was an independent predictor of overall survival but medullary bone invasion was not. Medullary bone invasion was an independent variable for distant control. The current T staging system has restricted prognostic utility. The authors recommend a modified T staging system, whereby tumors with <jats:styled-content style=\"fixed-case\">MC<\/jats:styled-content> invasion instead of medullary bone invasion are classified as T4a, and tumors are first classified as T1 to T3 based on size and then upstaged by one T classification in the presence of medullary invasion.<\/jats:p>","DOI":"10.1002\/cam4.899","type":"journal-article","created":{"date-parts":[[2016,10,19]],"date-time":"2016-10-19T06:13:09Z","timestamp":1476857589000},"page":"3378-3385","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Prognostic and staging implications of mandibular canal invasion in lower gingival squamous cell carcinoma"],"prefix":"10.1002","volume":"5","author":[{"given":"Masaya","family":"Okura","sequence":"first","affiliation":[{"name":"The First Department of Oral and Maxillofacial Surgery Graduate School of Dentistry Osaka University  Osaka 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