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Whitley CA, Ellis BG, Triantafyllou A, Gunning PJ, Gardner P, Barrett SD, Shaw RJ, Smith CI, Weightman P, Risk JM. Prediction of prognosis in oral squamous cell carcinoma using infrared microspectroscopy. Cancer Med 2024; 13:e7094. [PMID: 38468595 DOI: 10.1002/cam4.7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Estimation of prognosis of oral squamous cell carcinoma (OSCC) is inaccurate prior to surgery, only being effected following subsequent pathological analysis of the primary tumour and excised lymph nodes. Consequently, a proportion of patients are overtreated, with an increase in morbidity, or undertreated, with inadequate margins and risk of recurrence. We hypothesise that it is possible to accurately characterise clinical outcomes from infrared spectra arising from diagnostic biopsies. In this first step, we correlate survival with IR spectra derived from the primary tumour. METHODS Infrared spectra were collected from tumour tissue from 29 patients with OSCC and subject to classification modelling. RESULTS The model had a median AUROC of 0.89 with regard to prognosis, a median specificity of 0.83, and a hazard ratio of 6.29 in univariate Cox proportional hazard modelling. CONCLUSION The data suggest that FTIR spectra may be a useful early biomarker of prognosis in OSCC.
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Affiliation(s)
- Conor A Whitley
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Barnaby G Ellis
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories, University of Liverpool, Liverpool, UK
| | - Philip J Gunning
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Peter Gardner
- Department of Chemical Engineering, The University of Manchester, Manchester, UK
| | - Steve D Barrett
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Richard J Shaw
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Peter Weightman
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Janet M Risk
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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Surgical Extent for Oral Cancer: Emphasis on a Cut-Off Value for the Resection Margin Status: A Narrative Literature Review. Cancers (Basel) 2022; 14:cancers14225702. [PMID: 36428794 PMCID: PMC9688090 DOI: 10.3390/cancers14225702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
The optimal cut-off point of the resection margin was recently debated in oral cancer. To evaluate the current evidence of the dynamic criteria of the resection margin, a review of the available literature was performed. Studies were sourced from PubMed and EMBASE by searching for the keywords "mouth neoplasm", "oral cancer", "oral cavity cancer", "oral squamous cell carcinoma", "tongue cancer", "margins of excision", "surgical margin" and "resection margin". We found approximately 998 articles on PubMed and 2227 articles on EMBASE. A total of 3225 articles was identified, and 2763 of those were left after removing the duplicates. By applying advanced filters about the relevance of the subjects, these were narrowed down to 111 articles. After the final exclusion, 42 full-text articles were reviewed. The universal cut-off criteria of 5 mm used for determining the resection margin status has been debated due to recent studies evaluating the impact of different margin criteria on patient prognosis. Of note, the degree of the microscopic extension from the gross tumor border correlates with tumor dimensions. Therefore, a relatively narrow safety margin can be justified in early-stage oral cancer without the additional risk of recurrence, while a wide safety margin might be required for advanced-stage oral cancer. This review suggests a surgical strategy to adjust the criteria for risk grouping and adjuvant treatments, according to individual tumor dimensions or characteristics. In the future, it might be possible to establish individual tumor-specific surgical margins and risk stratification during or after surgery. However, the results should be interpreted with caution because there is no strong evidence (e.g., prospective randomized controlled studies) yet to support the conclusions. Our study is meaningful in suggesting future research directions and discussions.
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Variation in UK Deanery publication rates in the British Journal of Oral and Maxillofacial Surgery: where are the current 'hot spots'? Br J Oral Maxillofac Surg 2021; 59:e48-e64. [DOI: 10.1016/j.bjoms.2020.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
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Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features. Head Neck Pathol 2020; 15:461-468. [PMID: 32918712 PMCID: PMC8134593 DOI: 10.1007/s12105-020-01218-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
We set out to record the frequency of recognised adverse pathologic features in early oral squamous cell carcinoma (OSCC) and correlate with neck disease, in particular in small and thin carcinomas, a group that might be assumed to behave less aggressively. We also examined the possibility of a biopsy site interfering with assessment of WPOI5 in small tumors. We reviewed all OSCCs ≤ 20 mm size and ≤ 10 mm depth reported at our institution over a 5-year period. Tumor maximum dimension, depth, perineural invasion (PNI), lymphovascular invasion (LVI), worst pattern of invasion (WPOI), and nodal status were recorded. Out of 95 cases, there were 44 (46.3%) small and 78 (82.1%) thin OSCCs. Depth and WPOI were significant factors in predicting nodal disease. There were 41 (43.2%) OSCC that were small and thin, of which 9.8% had PNI, none had LVI, and 61% had WPOI 4 or 5. Their rate of PNI and of nodal disease was similar to the other early OSCC. Assessment of WPOI5 at a biopsy site was only a problem in 2/38 cases. In early OSCC, depth and WPOI are important factors in predicting nodal disease. The very earliest OSCC (small and thin) have a similar rate of PNI and of nodal disease to other early OSCC, suggesting that while there may be a tendency to de-escalate treatment, these small tumours should be managed in the same way as for all early OSCC. In addition, the presence of scarring due to a biopsy in very small carcinomas rarely affects assessment of WPOI5.
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Chatterjee D, Bansal V, Malik V, Bhagat R, Punia RS, Handa U, Gupta A, Dass A. Tumor Budding and Worse Pattern of Invasion Can Predict Nodal Metastasis in Oral Cancers and Associated With Poor Survival in Early-Stage Tumors. EAR, NOSE & THROAT JOURNAL 2019; 98:E112-E119. [PMID: 31072197 DOI: 10.1177/0145561319848669] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lymph node (LN) metastasis status. Early-stage (T1/T2 N0M0) OSCC comprises a heterogeneous group. We evaluated the role of histological parameters including worst pattern of invasion (WPOI) and tumor budding to determine the risk of LN metastasis in cases of OSCC and to determine the risk of recurrence and death in early-stage OSCC in north Indian patients. All cases of buccal mucosa and tongue SCC which underwent excision over 4 and half years were reviewed for histological parameters including histologic grade, WPOI, tumor budding, lymphovascular emboli (LVE), perineural invasion (PNI), depth of invasion (DOI), host lymphocyte response, and stromal response and compared to LN metastasis. Clinical follow-up of early-stage tumor was obtained and compared. A total of 126 cases of OSCC were included, of which 48 showed LN metastasis. Histological grade, WPOI, tumor budding (≥3/×40 field), LVE, and PNI were significantly associated with risk of LN metastasis. On multivariate analysis, WPOI and tumor budding were 2 most significant factors. Among the early-stage tumors with available follow up (n = 48), DOI, WPOI, tumor budding, and LVE were associated with a shorter overall survival, although it was not statistically significant. To conclude, WPOI and tumor budding are important risk factors for predicting LN metastasis in all stages of OSCC and associated with a poorer outcome in early-stage tumors. These are easy and reliable prognostic factors and should be included in the histopathological reporting guidelines.
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Affiliation(s)
- Debajyoti Chatterjee
- 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Vinisha Bansal
- 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Vipra Malik
- 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Ranjeev Bhagat
- 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Rajpal Singh Punia
- 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Uma Handa
- 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Anand Gupta
- 2 Department of Dentistry, Government Medical College and Hospital, Chandigarh, India
| | - Arjun Dass
- 3 Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College and Hospital, Chandigarh, India
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Jia J, Jia MQ, Zou HX. Lingual lymph nodes in patients with squamous cell carcinoma of the tongue and the floor of the mouth. Head Neck 2018; 40:2383-2388. [PMID: 30051610 DOI: 10.1002/hed.25340] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/26/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The treatment failure for oral squamous cell carcinoma (SCC) frequently takes the form of local and regional recurrences. We investigated the role of lingual lymph nodes (LLNs) in the recurrence of SCC of the tongue and the floor of the mouth. METHODS A total of 111 patients with SCC of the tongue and the floor of the mouth who received treatment between 2012 and 2017 were included in this study. The patients with lingual lymph nodes that were confirmed to be metastasis on pathological examination were classified into the LNN group. The demographic and clinical data differences between the No-LLN group and the LLN group were compared. Statistical analyses were performed using the Pearson chi-square test RESULTS: The total incidence of LLNs was 17.12% (19/111) and 5 patients (4.5%) demonstrated LLN metastases. All the patients with LLN metastases had a neck lymph node status of N2 classification. The incidence and metastasis of the LLNs were associated with pathological classifications of SCC of the tongue and the floor of the mouth. CONCLUSIONS LLNs are rare in patients with SCC of the tongue and the floor of the mouth, and they would be ready to be omitted. The dissection of these LLNs would be of benefit to those patients with advanced pathological grade.
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Affiliation(s)
- Jun Jia
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.,Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Meng-Qi Jia
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Hai-Xiao Zou
- Department of Stomatology, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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Loeffelbein D, Ritschl L, Güll F, Roth M, Wolff KD, Mücke T. Influence of possible predictor variables on the outcome of primary oral squamous cell carcinoma: a retrospective study of 392 consecutive cases at a single centre. Int J Oral Maxillofac Surg 2017; 46:413-421. [DOI: 10.1016/j.ijom.2016.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/11/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022]
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Wang Y, Zu X, Yi G, Luo H, Huang H, Song X. Ag Nanowire-Ag Nanoparticle Hybrids for the Highly Enhanced Fluorescene Detection of Protoporphyrin IX Based on Surface Plasmon-Enhanced Fluorescence. CHINESE J CHEM 2016. [DOI: 10.1002/cjoc.201600528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Will the mininvasive approach challenge the old paradigms in oral cancer surgery? Eur Arch Otorhinolaryngol 2016; 274:1279-1289. [DOI: 10.1007/s00405-016-4221-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023]
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Oral squamous cell carcinoma: the impact of stage-dependent therapy regimes on postoperative disease recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:133-8. [PMID: 26711710 DOI: 10.1016/j.oooo.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/06/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate disease recurrence among patients with oral squamous cell carcinoma (OSCC) and positive lymph node lesions receiving different therapy for different stages of the disease. STUDY DESIGN One hundred sixty-one patients with biopsy-proven pN1 and pN2+ carcinomas were reviewed retrospectively. We investigated postoperative disease recurrence when using surgery alone (SA), adjuvant radiotherapy (RT), or adjuvant radiochemotherapy (RCT) and compared our results with the 2012 German guidelines. RESULTS Among the study population, 60 (37%) experienced postoperative disease recurrence, 38% with SA, 42% with adjuvant RT, and 39% with adjuvant RCT (P = .420). In the case of pN1, the recurrence rate was 14% with SA, 32% with RT, and 33% with RCT (P = .156); and in pN2+, 60%, 49%, and 29%, respectively (P = .012). CONCLUSIONS Surgery plus adjuvant therapy has benefits with respect to postoperative disease recurrence in pN2+ OSCC. In pN1, surgery alone might be as effective as adjuvant RT or RCT.
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Dhanda J, Triantafyllou A, Liloglou T, Kalirai H, Lloyd B, Hanlon R, Shaw RJ, Sibson DR, Risk JM. SERPINE1 and SMA expression at the invasive front predict extracapsular spread and survival in oral squamous cell carcinoma. Br J Cancer 2014; 111:2114-21. [PMID: 25268377 PMCID: PMC4260028 DOI: 10.1038/bjc.2014.500] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Extracapsular spread (ECS) in cervical lymph nodes is the single-most prognostic clinical variable in oral squamous cell carcinoma (OSCC), but diagnosis is possible only after histopathological examination. A promising biomarker in the primary tumour, alpha smooth muscle actin (SMA) has been shown to be highly prognostic, however, validated biomarkers to predict ECS prior to primary treatment are not yet available. METHODS In 102 OSCC cases, conventional imaging was compared with pTNM staging. SERPINE1, identified from expression microarray of primary tumours as a potential biomarker for ECS, was validated through mRNA expression, and by immunohistochemistry (IHC) on a tissue microarray from the same cohort. Similarly, expression of SMA was also compared with its association with ECS and survival. Expression was analysed separately in the tumour centre and advancing front; and prognostic capability determined using Kaplan-Meier survival analysis. RESULTS Immunohistochemistry indicated that both SERPINE1 and SMA expression at the tumour-advancing front were significantly associated with ECS (P<0.001). ECS was associated with expression of either or both proteins in all cases. SMA+/SERPINE1+ expression in combination was highly significantly associated with poor survival (P<0.001). MRI showed poor sensitivity for detection of nodal metastasis (56%) and ECS (7%). Both separately, and in combination, SERPINE1 and SMA were superior to MRI for the detection of ECS (sensitivity: SERPINE1: 95%; SMA: 82%; combination: 81%). CONCLUSION A combination of SMA and SERPINE1 IHC offer potential as prognostic biomarkers in OSCC. Our findings suggest that biomarkers at the invasive front are likely to be necessary in prediction of ECS or in therapeutic stratification.
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Affiliation(s)
- J Dhanda
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - A Triantafyllou
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Regional Oral and Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - T Liloglou
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - H Kalirai
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - B Lloyd
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - R Hanlon
- Regional Oral and Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R J Shaw
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Regional Oral and Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D R Sibson
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J M Risk
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Wong DWH, Kamisetty A, Lowe D, Rogers SN. Frequency and outcomes of submandibular gland obstruction following resection of squamous cell carcinomas in the vicinity of the submandibular duct. Ann R Coll Surg Engl 2014; 96:602-5. [PMID: 25350183 DOI: 10.1308/003588414x14055925058436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to report rates, associated factors and outcomes of submandibular gland obstruction following surgery for squamous cell carcinoma in the anterior floor of the mouth (FOM) or ventral tongue without a neck dissection where resection has involved (or has been in very close proximity to) the submandibular duct. METHODS A retrospective case note review was carried out for the period January 2007 to December 2011. Only patients who received primary local surgical resection for squamous cell carcinoma of the anterior FOM or ventral tongue were included. RESULTS Fifty-two patients were analysed. Fifteen (29%) developed submandibular gland symptoms following surgery. Symptoms resolved spontaneously for 14 (93%) and 1 patient required the submandibular duct to be repositioned. Comparatively, 2 patients (13%) developed symptoms when the duct was repositioned during primary surgery. No patients had their submandibular gland removed. CONCLUSIONS Resection of small tumours associated with the FOM and ventral tongue in proximity to the submandibular duct is associated with obstructive symptoms in about a quarter of patients; this is reduced by half when redirecting the duct. Symptoms are self-limiting and self-resolving. A prospective clinical trial comparing duct repositioning with subcapsular gland excision would help clarify potential benefits and best treatment modalities.
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Barry CP, Ahmed F, Rogers SN, Lowe D, Bekiroglu F, Brown JS, Shaw RJ. Influence of surgical margins on local recurrence in T1/T2 oral squamous cell carcinoma. Head Neck 2014; 37:1176-80. [DOI: 10.1002/hed.23729] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/05/2014] [Accepted: 04/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Conor P. Barry
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Ferhan Ahmed
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Simon N. Rogers
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
- Evidence Based Practice Research Centre (EPRC), Faculty of Health; Edge Hill University; Ormskirk United Kingdom
| | - Derek Lowe
- Evidence Based Practice Research Centre (EPRC), Faculty of Health; Edge Hill University; Ormskirk United Kingdom
| | - Fazilet Bekiroglu
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - James S. Brown
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Richard J. Shaw
- Head and Neck Unit; Aintree University Hospital; Liverpool United Kingdom
- Department of Surgery and Oncology, School of Cancer Studies; University of Liverpool; Liverpool United Kingdom
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Almangush A, Bello IO, Keski-Säntti H, Mäkinen LK, Kauppila JH, Pukkila M, Hagström J, Laranne J, Tommola S, Nieminen O, Soini Y, Kosma VM, Koivunen P, Grénman R, Leivo I, Salo T. Depth of invasion, tumor budding, and worst pattern of invasion: prognostic indicators in early-stage oral tongue cancer. Head Neck 2013; 36:811-8. [PMID: 23696499 PMCID: PMC4229066 DOI: 10.1002/hed.23380] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/28/2013] [Accepted: 04/30/2013] [Indexed: 01/07/2023] Open
Abstract
Background Oral (mobile) tongue squamous cell carcinoma (SCC) is characterized by a highly variable prognosis in early-stage disease (T1/T2 N0M0). The ability to classify early oral tongue SCCs into low-risk and high-risk categories would represent a major advancement in their management. Methods Depth of invasion, tumor budding, histologic risk-assessment score (HRS), and cancer-associated fibroblast (CAF) density were studied in 233 cases of T1/T2 N0M0 oral tongue SCC managed in 5 university hospitals in Finland. Results Tumor budding (≥5 clusters at the invasive front of the tumor) and depth of invasion (≥4 mm) were associated with poor prognosis in patients with early oral tongue SCC (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.17–3.55; HR, 2.55; 95% CI, 1.25–5.20, respectively) after multivariate analysis. The HRS and CAF density did not predict survival. However, high-risk worst pattern of invasion (WPOI), a component of HRS, was also an independent prognostic factor (HR, 4.47; 95% CI, 1.59–12.51). Conclusion Analyzing the depth of invasion, tumor budding, and/or WPOI in prognostication and treatment planning of T1/T2 N0M0 oral tongue SCC is recommended.
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Affiliation(s)
- Alhadi Almangush
- Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland
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