A Predictive Model to Determine the Pattern of Nodal Metastasis in Oral Squamous Cell Carcinoma

Impact of histopathological parameters in prognosis of oral squamous cell carcinoma

OBJECTIVE

Squamous cell carcinomas comprise approximately 90% of all oral malignancies. There is a wide geographical variation in the incidence of oral cancer, with South and South East Asia (SSEA) accounting for almost two third of new cases. The prognosis of oral cancer is influenced by a vast array of factors including demographic, clinical, histopathological and molecular factors. The objective this review is to analyse the impact of histopathological features assessed in hematoxylin and eosin stained sections on the prognosis of OSCC.

MATERIALS AND METHODS

Medline and Scopus data base search was performed in order to identify related articles on histopathological parameters in predicting prognosis of oral squamous cell carcinoma. The primary emphasis is on the studies conducted in SSEA, with an accompanying comparison of their findings with those from research conducted in other parts of the world.

RESULTS

It has been shown that the number of studies conducted in SSEA is not proportionate to the high prevalence of Oral Cancer in the region. There is no significant difference between the findings from SSEA compared to the rest of the world. It is clearly shown that most histopathological parameters can be accurately used to predict nodal metastasis and prognosis.

CONCLUSIONS

Histopathological parameters can be used reliably in planning treatment of Oral cancer. Clinicians should combine clinical and histopathological parameters in drawing treatment plan for Oral Cancer.

Revisiting the Predictive Factors for Nodal Metastasis in Oral Cancers-a Leap Towards Personalized Patient Treatment Approach

The incidence of oral squamous cell carcinoma is steadily increasing globally, and even with a better understanding of tumor biology and advanced treatment modalities, the survival of OSCC patients is still not improved. A single metastatic cervical node can decrease survival by 50%. Our study intends to identify the clinical, radiological, and histological factors, significant for nodal metastasis in the pretreatment setting. Ninety-three patients' data is prospectively collected and analyzed to identify the significance of various factors in predicting nodal metastasis. Clinical factors like smokeless tobacco and nodal characteristics and T category and radiological factors like the number of specific nodes were significant for pathological nodes on univariate analysis. Ankyloglossia, radiological ENE, and radiological nodal size were significant on multivariate analysis also. In the pretreatment setting, clinicopathological and radiological factors can be used to predict nodal metastasis in generating predictive nomograms and for better planning of treatment.

Epidemiology and incidence of oral squamous cell carcinoma in the Iraqi population over 5 years (2014-2018)

Background

Oral squamous cell carcinoma is one of the most common and life-threatening neoplasms worldwide, and is responsible for approximately 90% of all oral malignancies.

Aim

This study was aimed at providing updated information on oral squamous cell carcinoma in all Iraqi governorates for the 5-year period from 2014 to 2018, including the annual incidence and demographic variables.

Materials and Methods

The total number of oral squamous cell carcinoma cases in Iraq, along with associated demographic information (age, sex, and site), for the 5-year period from 2014 to 2018 was obtained. The statistical analysis consisted of descriptive analysis, including frequency, percentage, and mean ± standard deviation. A χ ² test was performed to compare frequencies between male and female patients, among age groups, and among different OSCC sites. The χ ² test was also used to assess the association of each OSCC site with age and sex. The significance threshold was set at p < 0.05, and the confidence interval was set at 95%. The incidence rate of oral squamous cell carcinoma for each year was calculated by dividing the number of OSCC cases per year by the population of Iraq, then multiplying the result by 100,000.

Results

A total of 722 cases were recorded. Statistically, oral squamous cell carcinoma was found to be more prevalent in males and individuals over 40 years of age. The tongue was the most common site of occurrence. Lip squamous cell carcinoma cases were high in males. The incidence rate of oral squamous cell carcinoma was estimated to be 0.4 per 100,000 people.

Conclusion

Males and older people are at relatively higher risk of developing oral cancer. The tongue is the most affected site, but any site in the oral cavity may be involved. Further exploration of the causes of oral malignancy in Iraq is necessary to improve prevention strategies.

Artificial Neural Network Assisted Cancer Risk Prediction of Oral Precancerous Lesions

The incidence of oral cancer is still increasing. It has become very common in patients with malignant tumors, which has forced medical personnel to continuously explore its treatment methods. What kind of method can effectively and correctly diagnose the disease in the early stage and improve the survival rate has become one of the research topics that have attracted much attention. Aiming at this problem, it has great research significance for the field of oral precancerous lesions diagnosis. With the in-depth research on oral precancerous diagnosis, the research on artificial neural network (ANN) in medical diagnosis is gradually carried out. Its performance advantage is of great significance to solve the problem of early and correct disease diagnosis. This paper aimed to investigate the application of ANN-assisted cancer risk prediction method in risk prediction of oral precancerous lesions. Through the analysis and research of ANN and oral cancer, the construction of oral cancer risk prediction model was applied to solve the problem of improving the survival rate of oral cancer patients. In this paper, ANN and oral precancerous lesions were analyzed, the performance of the algorithm was experimentally analyzed, and the relevant theoretical formulas were used to explain. The results showed that the method had higher accuracy than traditional forecasting methods. When $N=2$ , the output accuracy was above 90%. It can be seen that the algorithm can meet the needs of the diagnosis of high-risk groups of oral cancer lesions, and the diagnosis efficiency and patient survival rate has been greatly improved.

Evaluation of Histomorphological Parameters to Predict Occult Nodal Metastasis in Early-Stage Oral Squamous Cell Carcinoma

OBJECTIVE

The oral squamous cell carcinoma (OSCC) treatment protocol depends upon lymph node metastasis. Elective neck dissection for early-stage OSCC (pT1/T2) elective neck dissection reduces the morbidity rate. It also reduces the overall survival and thus it becomes important to detect lymph node metastasis in early-stage OSCC.

MATERIAL AND METHOD

Various histomorphological parameters have been studied to predict nodal metastasis in early-stage OSCC. We aim to evaluate these parameters in the context of nodal metastasis. 78 cases of early-stage OSCC were included in the study with histopathologic parameters like tumor size, grade, tumor depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion (PNI), worst pattern of invasion (WPOI), and lymph node level.

RESULTS

Out of the 78 patients, 32 patients had lymph node metastasis. T stage, DOI, LVI, and WPOI showed statistically significant deviance from the null model (P-values of 0.007, 0.01, 0.04 and 0.02 respectively). The Odds Ratio (OR) of T stage, DOI, LVI and WPOI were 4.45 (95% C.I =1.47-14.1), 4.4 (95% C.I =1.32-15.88), 8.12 (95% C.I =1.002-198.20), and 3.39 (95% C.I =1.24-9.74) respectively. On multivariate analysis (Firth logistic regression) using DOI, LVI, and WPOI as independent variables, only T-stage and WPOI retained statistical significance.

CONCLUSION

The prognostic information supplied by evaluating DOI, LVI, and WPOI warrants the inclusion of these parameters in the standard reporting format for all cases of OSCC.

Development and Validation of a Nomogram based on cell growth-related Biomarkers for Oral Squamous Cell Carcinoma

Purpose: We aimed to develop a prognostic nomogram based on immunohistochemistry (IHC) biomarkers of patients with oral squamous cell carcinoma (OSCC). Methods: A total of 294 patients were enrolled in the study. The least absolute shrinkage and selection operator (LASSO) Cox regression model was performed to develop a combined IHC score (IHCs) classifier. Results: Five biomarkers, specifically c-Met, Vimentin, HIF-2α, VEGF-c, and Bcl-2 were extracted. Then, an IHCs classifier was developed, and patients were stratified into high- and low-IHCs groups. In the training cohort, the 5-year overall survival (OS) was 62.1% in low-IHCs group and 28.2% in high-IHCs group (P<0.001). The 5-year OS was 68.6% for the low-IHCs group and 28.4% for the high-IHCs group in the validation cohort (P<0.001). The area under the ROC curve (AUROC) of the combination of the IHCs classifier and TNM stage was 0.746 (95% CI: 0.658-0.833) in the training cohort and 0.735 (95% CI: 0.651-0.818) in the validation cohort, respectively. Conclusions: The nomogram could effectively predict the prognosis for patients with OSCC and may be employed as a potential tool to guide the individual decision-making process.

Correlative study of tumor budding, mode of invasion and lymphocytic host response with known clinicopathological prognostic factors in oral squamous cell carcinoma

Background

Oral squamous cell carcinoma (OSCC) is a significant public health problem in India, accounting to 30% of all cancers with a worrying rise in incidence and related mortality. Invasive tumor front (ITF) of OSCC has been an area of histopathologic research interest, where parameters like tumor budding (TB), mode of invasion (MOI) and lymphocytic host response (LHR) are being evaluated extensively.

Objectives

The aim is to study and evaluate the possible association of ITF histological parameters such as TB, LHR and MOI with known clinicopathological prognostic factors in cases of OSCC.

Subjects and Methods

We reviewed and analyzed 69 cases of OSCC for routine clinicopathological parameters, TB, MOI and LHR for any significant correlation (P < 0.05 by Chi-square test) with each other and with outcome in cases where follow-up was available.

Results

TB correlated significantly with histological grade, worst pattern of invasion (WPOI), Lymphnodal involvement (LNI), Lymphovascular invasion (LVI), Perineural invasion (PNI) and age; MOI correlated with WPOI, LNI, LVI and PNI; and LHR significantly correlated with WPOI, PNI, Tumor size (pT) and outcome. TB showed a strong correlation with MOI (P < 0.001) and LHR; and no significant association was noted between LHR and MOI. Among all the clinicopathological parameters, depth of invasion, pT, WPOI, PNI and LHR showed significant correlation with outcome.

Conclusion

TB, MOI and LHR showed good correlation with established parameters and as they are easy and helps in prognostication, they should be included in routine histopathological reporting guidelines.

Postoperative radiotherapy is associated with improved overall survival for alveolar ridge squamous cell carcinoma with adverse pathologic features

BACKGROUND

Alveolar ridge squamous cell carcinoma (ARSCC) is poorly represented in randomized trials.

METHODS

Adults in the National Cancer Database diagnosed with ARSCC between 2010 and 2014 who should be considered for postoperative radiotherapy (PORT) based on National Comprehensive Cancer Network (NCCN)-defined risk factors were identified.

RESULTS

Eight hundred forty-five (58%) of 1457 patients meeting the inclusion criteria received PORT. PORT was associated with improved overall survival (OS) on unadjusted (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.70-0.98, P = .02) and multivariable (HR 0.78, 95% CI 0.64-0.94, P = .002) analyses. PORT was associated with significantly improved 5-year OS for patients with 1 (68% vs 58%, P < .001), 2 (52% vs 31%, P < .001), and ≥3 (38% vs 24%, P < .001) NCCN-defined risk factors. Prognostic variables significantly associated with worse OS on multivariable analysis included advanced age, primary tumor size ≥3 cm, high grade, positive margin(s), stage N2-3, level IV/V nodal metastasis, and extranodal extension.

CONCLUSION

PORT for resected ARSCC with adverse pathologic features is associated with significantly improved OS.

miR-146b Functions as an Oncogene in Oral Squamous Cell Carcinoma by Targeting HBP1

Oral squamous cell carcinoma (OSCC) represents more than 90% of all oral cancer and is the most common oral threat around the world. In this study, we examined the roles of miR-146b in OSCC cells. The miR-146b expression in OSCC tissues and cell lines was evaluated by quantitative real-time PCR (qRT-PCR). MTT assay was used to investigate the impact of miR-146b on the growth of OSCC cells in vitro. Transwell assay was utilized to analyze the effect of miR-146b on the migration and invasion of OSCC cells. Target prediction and luciferase assay were employed to demonstrate the interaction between miR-146b and HMG-Box Transcription Factor 1 (HBP1). Western blot was carried out to investigate the protein expressions of HBP1 related genes. miR-146b expression was significantly higher in OSCC tissues and cells compared with paired normal tissues and normal oral keratinocyte cells. Inhibition of miR-146b decreased cell proliferation, migration, and invasion of OSCC cells. Further studies found that HBP1 was a direct target of miR-146b. Co-inhibition of HBP1 reversed the suppressive impact of miR-146b inhibition on OSCC cell proliferation, migration, and invasion. In conclusion-ourresults reveal that miR-146b potentially regulates the proliferation, migration, and invasion of OSCC cells through binding and downregulating HBP1 expression in OSCC cells.

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.

Development of clinico-histopathological predictive model for the assessment of metastatic risk of oral squamous cell carcinoma

CONTEXT:

Oral cancer metastasis is the leading cause of death globally. The decision-making on the mode of surgical treatment in clinically negative lymph nodes is challenging.

AIM:

The aim of this study was to develop a predictive model using clinical and histopathologic parameters that may help in the assessment of the metastatic risk of oral squamous cell carcinoma (OSCC).

SETTINGS AND DESIGN:

Clinical data of histopathologically confirmed primary OSCC from 2014 to 2017 were retrieved from the archives. Histopathological parameters for metastasis that were considered for evaluation in the study were tumor buds, cytoplasmic pseudofragments, tumor grade, depth of invasion, invasive tumor front (ITF) pattern, and lymphovascular invasion (LVI).

METHODS:

Hematoxylin and eosin and pan-cytokeratin immunostained sections of metastatic and nonmetastatic OSCC were assessed for histopathological features and correlated with clinical parameters.

STATISTICAL ANALYSIS USED:

SPSS software (Statistical Package for Social Sciences for Windows, Version 22.0 (2013) (IBM Corp., Armonk, NY, USA)) was used for the statistical analysis. Pearson's Chi-square test was done to assess the grades of histopathological and clinical parameters between the study groups. Univariate analysis was performed to develop a clinicopathologic predictive model.

RESULTS:

The clinicopathologic model signifies that OSCC with clinical Stage IV, high grades of tumor buds and cytoplasmic pseudofragments, Type V ITF pattern, positive LVI, deeply invasive tumors, and poorly differentiated grades of OSCC have a high risk of developing nodal metastasis. These parameters may be used as early predictors for metastasis of OSCC both in incisional and excisional biopsy specimens.

CONCLUSIONS:

The proposed predictive model is simple, cost-effective, and user-friendly for the early assessment of nodal metastatic risk in clinically negative lymph nodes.