Prognostic significance of tumor shape and stromal chronic inflammatory infiltration in squamous cell carcinomas of the oral tongue

Correlation of Pattern of Invasion, Stromal Inflammation and Lymphovascular Invasion With Histopathological Grading in Oral Squamous Cell Carcinoma: A Retrospective Study

INTRODUCTION

Despite the progress in diagnostics and treatment modalities, the survival rate of oral squamous cell carcinoma (OSCC) patients has remained unchanged. Early diagnosis of the disease helps in better treatment and prognosis. Identifying clinicopathological and histopathological parameters that help predict disease progression is crucial.

OBJECTIVES

To assess the significance of various clinical and histopathological factors in OSCC and to correlate the patterns of invasion of tumour (POI), stromal inflammation, and lymphovascular invasion with the histopathological grading of OSCC.

MATERIALS AND METHODS

This study included 30 oral squamous cell carcinoma cases from 2015 to 2021. The surgically operated cases of OSCC were obtained from the archives of the Oral Pathology Department. The subjects were categorized according to the degree of differentiation of OSCC. The parameters like the pattern of invasion of tumour (POI), stromal inflammation, and lymphovascular invasion were assessed and correlated with the different histopathological grades of OSCC.

RESULTS

We observed a statistically significant correlation between the pattern of invasion and stromal inflammation with histopathological grades of OSCC. There was no significant association between lympho-vascular invasion and histopathological grades of OSCC.

CONCLUSION

We conclude that histopathological parameters like the pattern of invasion and stromal inflammation significantly impact different grades of OSCC. These parameters should be included in routine histo-pathological reports for predicting clinical outcomes and management of the disease.

Peri-tumoral infiltrate associates with postoperative prognosis of patients with OSCC: Stronger association in HPV negative patients

PURPOSE

The current data on the relationship between local inflammatory infiltration and prognosis in oral squamous cell carcinoma (OSCC) are limited and controversial, especially in different HPV status. In this study, we analyzed the relationship between peri-tumoral inflammatory infiltrate (PTI) and HPV status and prognosis of patients with OSCC after surgery.

METHODS

A retrospective cohort of 99 primary OSCC patients who underwent surgery was constructed. P16 immunohistochemistry was used to determine HPV status. PTI was determined by hematoxylin-eosin staining and quantified into four levels: none (Score 0), weak (Score 1), moderate (Score 2) and strong (Score 3). The associations of PTI with clinico-pathological characteristics, HPV status and survival were examined.

RESULTS

Most OSCC patients had weak to moderate PTI. PTI was significantly associated with lymph node metastasis (P = 0.041), and patients with moderate PTI had significantly better OS (P = 0.009) than those with no PTI. In HPV negative OSCC, patients with moderate PTI also had significantly better OS (P = 0.019) than those with no PTI. However, PTI was not significantly associated with survival in HPV positive OSCC.

CONCLUSIONS

In HPV negative OSCC, moderate PTI may suggest a better postoperative prognosis than no PTI.

Histopathological Factors in Oral Squamous Cell Carcinoma-Should a Clinician Look Beyond Clinical Staging?

PURPOSE

Several researchers have proposed and investigated the prognostic implications of various parameters, but have failed to provide concrete evidence regarding the inclusion or exclusion of histopathological features while clinically managing an oral squamous cell carcinoma (OSCC) case. The study purpose was to measure the prognostic values of a set of key histologic features and its association with its clinical outcome-5-year survival.

MATERIALS AND METHODS

This is a prospective cohort study and the sample was composed of patients treated for OSCC (April 2014 - March 2015). The predictor variables included pattern of tumor invasion (POI), stromal inflammation, angiogenesis, and vascular invasion with the outcome being survival of subjects observed over this 5-year period. Sociodemographic data (age, sex, marital status, systemic disease, habits etc), clinical staging and TNM staging were also recorded. We used multivariate regression analysis for predictor analysis; Kaplan-Meier survival curves and Cox hazard modeling was also performed using the data.

RESULTS

This article includes 50 subjects with a mean age of 54.94 years and 58% were male and their characteristics collected at the baseline and at a 12-, 24-, 36-, 48-, and 60-month follow-up. The overall 5-year survival was 48%. We saw a significant association between N-stage and POI (0.027), T-stage and mean vascular density (0.042), and T-stage and vascular invasion (0.046). POI, angiogenesis, and vascular invasion were found as significant predictors of overall 5-year survival (P < .001).

CONCLUSIONS

This study shows that histopathological parameters such as POI are important while determining the clinical outcome of OSCC. Histopathological parameters such as angiogenesis and vascular invasion can provide valuable information about the overall survival and prognosis.

Impact of Histological and Molecular Parameters on Prognosis of Oral Squamous Cell Carcinoma: Analysis of 290 Cases

Background

Nodal metastasis is a critical factor in predicting the prognosis of oral squamous cell carcinoma (OSCC). When patients present with a clinically positive neck, the treatment of choice is radical neck dissection. However, management of a clinically negative neck is still a subject of significant controversy.

Aim

This study was carried out in order to propose a model to predict regional lymph node metastasis of OSCC using histological parameters such as tumour stage, tumour size, pattern of invasion (POI), differentiation of tumour, and host immune response, together with the expression levels of six biomarkers (periostin, HIF-1α, MMP-9, β-catenin, VEGF-C, and EGFR), and, furthermore, to compare the impact of all these parameters on recurrence and 3 yr and 5 yr survival rates. Materials and Method. Histological materials collected from the archives were used to evaluate histological parameters and immunohistochemical profiles. Standard methods were used for immunohistochemistry and for evaluation of results. Data related to recurrence and survival (3 and 5 years) was also recorded. Clinical data was collected from patients' records.

Results

Male to female ratio was 3 : 1. The commonest site of OSCC was the buccal mucosa, and majority of them were T3 or T4 tumours presented at stage 4. 62.5% of the tumours were well differentiated. Three-year and 5-year survival rates were significantly associated with lymph node metastasis and recurrence. POI was significantly correlated with tumour size, stage, 3-year survival, EGFR, HIF-1α, periostin, and MMP-9 (p < 0.05). Expression of EGFR showed a direct association with metastasis (p < 0.05).

Conclusion

POI, level of differentiation, and expression of EGFR are independent prognostic markers for lymph node metastasis. Therefore, these parameters may help in treatment planning of a clinically negative neck.

Pattern of tumor invasion, stromal inflammation, angiogenesis and vascular invasion in oral squamous cell carcinoma - A prognostic study

INTRODUCTION

Oral cancer is one of the leading causes of mortality, and its worsening impact on the society has revealed the danger it poses in the coming future. Several researchers proposed and investigated the prognostic implications of various clinicopathologic and histopathologic parameters.

AIM AND OBJECTIVES

The aim of this study--assessing significance of histopathological features like pattern of tumor invasion, stromal inflammation, angiogenesis and vascular invasion on the clinical outcome of oral squamous cell carcinoma any possible correlations between the parameters, TNM Staging and prognosis were assessed and evaluated for a 5-year period.

MATERIALS AND METHODS

This study includes description of 50 diagnosed cases (mean age: 61.40, 29 males, and 21 females) of oral squamous cell carcinoma and their characteristics collected at baseline and at a 12-month follow up. The cases were grouped on the basis of their histological grade (well-differentiated, moderately differentiated, and poorly-differentiated).

RESULTS

All the data collected was tabulated in a baseline descriptive table, and all the parameters were compared between the 3 different histological groups. On cross-tabulations we found statistical significant difference the parameters of stromal inflammation with recurrence, clinical stage with T-stage, T-stage with N-stage, and N-stage with clinical stage. On analysis of the follow up we found 16 patients (32%) with recurrence and 9 patients (18%) succumb to the disease.

CONCLUSION

This study provides a significant insight on the importance of a combined histopathological analysis and clinical staging process to deliver an accurate prognostic opinion and also subsequently effect the treatment protocol.

Tumor-Infiltrating CD1a+ DCs and CD8+/FoxP3+ Ratios Served as Predictors for Clinical Outcomes in Tongue Squamous Cell Carcinoma Patients

Tumor-infiltrating immune cells engage in an extensive crosstalk with tumors and act as two-edged swords by inhibiting or promoting cancer growth. Therefore, identifying the density and prognostic values of tumor-infiltrating immune cells will provide valuable tips for cancer treatments. In this study, we identified the density of tumor inflammatory infiltrates and the number of tumor-infiltrating immune cells, including CD3⁺, CD4⁺, CD8⁺, FoxP3⁺ T cells and CD1a⁺ dendritic cells (DCs) in 153 tongue squamous cell carcinomas (TSCC). High inflammatory cell infiltration was associated with better overall survival (OS) and disease free survival (DFS). Moreover, the number of CD3⁺, CD4⁺, FoxP3⁺ and CD1a⁺ cells were associated with tumor differentiation (P<0.001) and the number of FoxP3⁺, CD1a⁺ cells and CD8⁺/FoxP3⁺ ratios were also associated with tumor stage (P<0.01, P<0.01, P<0.05). In addition, patients with higher CD1a⁺ DCs had better OS and increased CD8⁺/FoxP3⁺ ratios were associated with improved OS and DFS (P = 0.037; P = 0.047; P = 0.033). In conclusion, our results indicated that tumor-infiltrating CD1a⁺ DCs and CD8⁺/FoxP3⁺ ratios were associated with favorable clinical outcomes but not independent prognostic factors for TSCC patients.

Comprehensive analysis of lung cancer pathology images to discover tumor shape and boundary features that predict survival outcome

Pathology images capture tumor histomorphological details in high resolution. However, manual detection and characterization of tumor regions in pathology images is labor intensive and subjective. Using a deep convolutional neural network (CNN), we developed an automated tumor region recognition system for lung cancer pathology images. From the identified tumor regions, we extracted 22 well-defined shape and boundary features and found that 15 of them were significantly associated with patient survival outcome in lung adenocarcinoma patients from the National Lung Screening Trial. A tumor region shape-based prognostic model was developed and validated in an independent patient cohort (n = 389). The predicted high-risk group had significantly worse survival than the low-risk group (p value = 0.0029). Predicted risk group serves as an independent prognostic factor (high-risk vs. low-risk, hazard ratio = 2.25, 95% CI 1.34–3.77, p value = 0.0022) after adjusting for age, gender, smoking status, and stage. This study provides new insights into the relationship between tumor shape and patient prognosis.

Comparison of the histologic risk assessment model between lower lip and oral squamous cell carcinoma

INTRODUCTION

The histologic risk assessment (HRA) grading system was proposed as a practical measure to predict clinical outcome and its effectiveness has been shown in several studies. It has been suggested that the HRA model might exhibit differences among various oral subsites. The aim of the present study was to compare this system between squamous cell carcinomas (SCCs) of the lower lip (LL) and oral cavity.

MATERIALS AND METHODS

All primary SCCs located in the LL and oral cavity were retrieved and graded using the HRA model. Data regarding risk score (RS), perineural invasion (PNI), lymphocytic infiltration (LI) and worst pattern of invasion (WPOI) were compared between LL and oral SCCs using χ² analysis (P<0.05).

RESULTS

There were a total of 33 LLSCCs, of which 15, 8 and 10 were categorized as low-risk (RS=0), intermediate-risk (RS=1-2) and high-risk (RS≥3) tumors, respectively. Corresponding values in the 48 oral SCCs were 7, 15 and 26 cases. Significant differences in RS (P=0.00), LI (P=0.01) and WPOI (P=0.01) were observed between LL and oral tumors.

CONCLUSIONS

The HRA model could be included among the various factors suggested to be different between lip and oral SCCs. Low-risk tumors were more prevalent in the lip which corroborates the less aggressive nature of these cancers. Considering the significantly higher LI in LL SCCs, inflammation may be regarded as an important factor in regulating the invasive behavior of these tumors.

Low-risk population among patients with tumor-node-metastasis stage III/IV oral squamous cell carcinoma

A novel system auxiliary to the Union for International Cancer Control classification may allow the prognosis of patients with malignant tumors at similar stages to be predicted, as currently this is challenging. The present study generated a novel system to predict populations at low risk among patients with stage III/IV oral squamous cell carcinoma (OSCC). A total of 41 patients who were diagnosed at stages III/IV OSCC and underwent surgical tumor resection were analyzed. Band-like or follicular lymphocyte infiltration, intraepithelial micro-abscess formation and natural killer (NK) cell infiltration were histopathologically evaluated. Cox's proportional hazards regression model was used to identify prognostic factors, and a set of factors was selected from a combination of those prognostic factors to create a logic covariate model. A logic regression analysis for 41 patients with OSCC revealed that the presence of intraepithelial micro-abscesses and a lower density of NK cells were significantly associated with a favorable prognosis among patients with stage III/IV OSCC. These results suggested that the host innate immune responses, including neutrophil and NK cell infiltrations, are useful for prognostic prediction in patients with advanced malignant tumors.

Histological subtypes of oral non-tonsillar squamous cell carcinoma in dogs

Several histological subtypes and grades of oral squamous cell carcinoma (SCC) are described in human literature and these subtypes have distinct morphological features and biological behaviour. This retrospective study (1990-2010) included 84 dogs diagnosed with SCC of the oral cavity and oropharynx, excluding the tonsils. Sixty-nine of the SCCs (82.1%) were further diagnosed as conventional SCC (CSCC) (33 [47.8%] well-differentiated, 31 [44.9%] moderately-differentiated and five [7.3%] poorly-differentiated), five (5.95%) each as papillary SCC and basaloid SCC, three (3.6%) as adenosquamous carcinoma and two (2.4%) as spindle cell carcinoma. Compared with the general hospital population, neutered female dogs, dogs aged 10 to <15 years, English springer spaniels and Shetland sheepdogs were overrepresented. The majority (78.1%) of SCCs were proliferative with or without associated ulceration, although no significant association was observed between the gross appearance and different SCC subtypes. 71.4% of SCCs were located in dentate jaws; however, well-differentiated CSCC more often affected the tongue and other non-dentate mucosal surfaces (P=0.0022). No significant association was found between any of the SCC subtypes and tumour-associated inflammation (TAI), perineural and lymphovascular invasion (PNI, LVI), or between gross appearance of the tumour and tumour location, PNI, LVI or TAI or PNI, LVI, TAI and tumour location.

Analysis of inflammatory infiltrate, perineural invasion, and risk score can indicate concurrent metastasis in squamous cell carcinoma of the tongue

PURPOSE

In this retrospective study, the aim was to compare individual histopathologic parameters of malignancy between nonmetastatic and metastatic squamous cell carcinoma of the tongue.

MATERIALS AND METHODS

Sixty-two cases of squamous cell carcinoma of the tongue were selected and examined according to the system established by Brandwein-Gensler et al (Am J Surg Pathol 29:167, 2005) and included the pattern of invasion (most to least favorable), lymphocytic infiltration, perineural invasion, risk score, keratinization, eosinophilia, perivascular invasion, and tumor thickness.

RESULTS

The least favorable pattern had no association with nodal metastasis (P > .05). The scarcity or density of the lymphocytic infiltration, perineural invasion, and a risk score ≥ 3 were associated with nodal metastasis (P < .05). Keratinization, eosinophilia, perivascular invasion, and tumor thickness had no association with nodal metastasis (P > .05). A significant positive correlation was found between the pattern of invasion and perineural invasion and between the pattern of invasion and tumor thickness (P < .05).

CONCLUSIONS

The scarcity or density of the lymphocytic infiltration, perineural invasion, and histopathologic risk score may be helpful as parameters of histologic malignancy for the evaluation of metastatic and nonmetastatic squamous cell carcinoma of the tongue.

The importance of stromal inflammation in squamous cell carcinoma of the tongue

BACKGROUND

Histological risk assessment evaluating worst pattern of tumour invasion (WPOI), and lymphocytic response (LR), has previously been shown to be of prognostic significance in squamous cell carcinomas of the head and neck (SCCHN). SCCHN is a heterogeneous group of tumours including tumours located in the oral cavity, of which the majority is located in the tongue.

METHODS

Haematoxylin/eosin-stained slides from diagnostic biopsies from 94 cases of SCC on the tongue were evaluated for WPOI and LR. Within the inflammatory infiltrate, the percentage of eosinophilic granulocytes was also estimated. Results were correlated with clinical data such as response to treatment and recurrence.

RESULTS

For WPOI the majority of patients, 84%, showed small invasive tumours islands with a size <15 cells (grade 4). No correlation with survival, response to treatment or recurrence was seen for WPOI. More than half of the patients showed a dense lymphocytic infiltrate, a factor that was significantly correlated with complete response to radio therapy. Of the patients with dense lymphoid infiltrate, the majority, 63%, did not either have a recurrence. No significant correlation with recurrence, response to treatment or any other factor was seen for presence of eosinophils.

CONCLUSIONS

Data clearly showed that tongue tumours have a split invasive growth pattern and an intense inflammatory response at the tumour interface. Results also indicated that evaluation of the intensity of the inflammatory infiltrate at the tumour interface in tongue SCC could provide information of potential importance for choice of treatment and prognosis.