A combined histo-score based on tumor differentiation and lymphocytic infiltrate is a robust prognostic marker for mobile tongue cancer

Abstract

We wanted to evaluate the prognostic value of common histopathological variables in a large cohort of patients with cancer in the mobile tongue as such information can be important for treatment stratification of the individual patient, especially for patients with low-stage disease. In addition, we wanted to investigate whether an alternative scoring model with fewer options would compromise the prognostic value. One hundred fifty patients with oral tongue squamous cell carcinomas that were treated in curative intent and with available HE-stained tumor sections were included. We reclassified all tumors and performed univariate and multivariate survival analyses of histopathological and clinical variables. For the complete cohort, lymph node status, grade of differentiation, perineural infiltration, and lymphocytic infiltration were independent prognosticators. In the low-stage disease group, independent prognostic factors were tumor size, grade of differentiation, and lymphocytic infiltrate. For patients with low-stage disease, a histo-score combining the scores for tumor differentiation and lymphocytic infiltrate identified a group of patients with particularly low survival, as patients with moderately or poorly differentiated tumors and little lymphocytic infiltrate had a less favorable 5-year survival outcome than patients in the high-stage disease group. This study shows that a histo-score combining tumor differentiation and lymphocytic infiltration should be given special consideration in treatment planning. Our results also illustrate that many variables can be scored with fewer options than previously suggested to increase their reproducibility, and still maintain their prognostic value.

Combined loss of expression of involucrin and cytokeratin 13 is associated with poor prognosis in squamous cell carcinoma of mobile tongue

“…OTSCC/OSCC cases with poorly differentiated phenotype have been shown to have poor prognosis. 40,41 In agreement with these observations, OTSCC cases with combined loss of CK13 and IVL expression at invading cores was significantly associated with poorer 5-year overall survival (Figure 4(E,F)). Multivariate Cox regression analysis further indicated that the combined loss of IVL and CK13 at invading core was an independent prognostic factor (HR = 0.38, CI = 0.17-0.85, p = 0.02) in OTSCC.…”

“…OTSCC/OSCC cases with poorly differentiated phenotype have been shown to have poor prognosis 40,41 . In agreement with these observations, OTSCC cases with combined loss of CK13 and IVL expression at invading cores was significantly associated with poorer 5‐year overall survival (Figure 4(E,F)).…”

Emerging histopathologic markers in early‐stage oral tongue cancer: A systematic review and meta‐analysis

“…Regarding the emerging prognostic markers that are not included in the pathology report, the published studies revealed a promising prognostic value for cancer‐related histopathologic markers including cell‐in‐cell structures (one study), 19 tumor budding (seven studies), 13,15,25–29 and pattern of invasion (15 studies) which were evaluated either as mode of invasion, 22,30 pattern of invasion, 31–34 invasive pattern, 28 or WPOI 13,16,25,35–39 . At the same time, some of the relevant studies analyzed stromal‐related histopathologic markers including stromal infiltrating lymphocytes (one study) 18 and tumor–stroma ratio (TSR; three studies) 17,40,41 which were significantly associated with prognosis.…”

Biomarkers for Immunotherapy of Oral Squamous Cell Carcinoma: Current Status and Challenges

“…Most recently (2020), Bjerkli et al. proposed a histo-score based on the assessment of the lymphocytic infiltrate and tumor differentiation, and showed that the score gave a good prediction of survival in oral tongue cancer ( 14 ). Our group ( 15 ) proposed stromal classification, based on the assessment of tumor-infiltrating lymphocytes and tumor-stroma ratio, with a promising prognostic value in early oral tongue cancer.…”

“…Brandwein-Gensler et al (13) assessed the immune response as a part of a histologic risk score including three parameters: worst pattern of invasion, perineural invasion and lymphocytic host response (13). Most recently (2020), Bjerkli et al proposed a histo-score based on the assessment of the lymphocytic infiltrate and tumor differentiation, and showed that the score gave a good prediction of survival in oral tongue cancer (14). Our group (15) proposed stromal classification, based on the assessment of tumorinfiltrating lymphocytes and tumor-stroma ratio, with a promising prognostic value in early oral tongue cancer.…”