Addition of the tumour–stroma ratio to the 8th edition American Joint Committee on Cancer staging system improves survival prediction for patients with oral tongue squamous cell carcinoma

Abstract

Aims One of the objectives of current research is to customise the treatment of cancer patients. The achievement of this objective requires stratification of patients based on the most significant prognostic factors. The aims of this study were to evaluate the prognostic value of the tumour–stroma ratio (TSR), defined as the proportion of tumour cells relative to surrounding stroma, in patients with oral tongue squamous cell carcinoma (OTSCC), and to develop a prognostic nomogram based on the most significant clinicopathological features. Methods and results Clinicopathological data of 211 patients treated at ‘Ospedali Riuniti’ General Hospital (Ancona, Italy) for OTSCC were collected. One hundred and thirty‐nine patients were restaged according to the 8th edition American Joint Committee on Cancer (AJCC) staging system. Evaluation of the TSR was performed on haematoxylin and eosin‐stained slides, and correlation with survival outcomes was evaluated. In addition, with the aim of integrating the independent value of the TSR with the 8th edition AJCC staging system, a prognostic nomogram for OTSCC has been developed. OTSCC with a low TSR (i.e. a high proportion of stroma and a low proportion of tumour cells) was shown to have negative prognostic value in terms of disease‐specific survival, with a hazard ratio (HR) of 1.883 and a 95% confidence interval (CI) of 1.033–3.432 (P = 0.039), and overall survival (HR = 1.747, 95% CI 0.967–3.154; P = 0.044), independently of other histological and clinical parameters. For the cohort of 139 patients restaged according to the 8th edition AJCC staging system, variables correlating with a poor prognosis were: the TSR, perineural invasion, and sex. The nomogram built on these parameters showed good predictive capacity, outperforming the 8th edition AJCC staging system in stratifying disease‐specific survival in OTSCC patients. Conclusions Including the TSR in the predictive model could improve risk stratification of OTSCC patients and aid in making treatment decisions.

Prognostic Value of Perineural Invasion in Oral Tongue Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

“…Table 1 presents the characteristics of the studies (20,(25)(26)(27)(28)(29)(30)(31)(32)(43)(44)(45)(46)(47)(48)(49)(50), including one RCT (43), three prospective cohort studies (44)(45)(46), and 13 retrospective studies (20,(25)(26)(27)(28)(29)(30)(31)(32)(47)(48)(49)(50). Eight studies were from Asia (20,30,32,43,44,46,47,50), one was Australia (45), three were from Europe (25,28,29), and five were from North America (26,27,31,48,49). The 17 studies included a total of ...…”

“…PNI is associated with the depth of invasion of OTSCC (22) and cervical lymph node involvement and might suggest consideration for elective neck dissection (23), even in stage 1 and 2 diseases (24). A significant number of recently published research has outlined the contribution of PNI to clinical outcomes in OTSCC (10,(19)(20)(21)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Some authors advocate incorporating PNI in the staging systems for OTSCC (34).…”

The immune phenotype of tongue squamous cell carcinoma predicts early relapse and poor prognosis

“…3 Interestingly, recent studies have shown that oral tongue squamous cells carcinoma (OTSCC) exhibits peculiar molecular and clinical behavior compared to OSCC from other subsites of the oral cavity. [4][5][6][7] If not properly recognized, the presence of this potential "anatomical bias" may hinder the interpretation and clinical translation of OSCC data. 8,9 The surgical resection of primary OTSCC, with or without neck dissection, is still considered the gold standard of treatment.…”

“…Oral squamous cell carcinoma encompasses cancers developing in various sites of the oral cavity, and intraoral tongue is the most commonly involved subsite, accounting for about 40% of all OSCC cases 3 . Interestingly, recent studies have shown that oral tongue squamous cells carcinoma (OTSCC) exhibits peculiar molecular and clinical behavior compared to OSCC from other subsites of the oral cavity 4‐7 . If not properly recognized, the presence of this potential “anatomical bias” may hinder the interpretation and clinical translation of OSCC data 8,9 …”

Comprehensive Evaluation of PAXgene Fixation on Oral Cancer Tissues Using Routine Histology, Immunohistochemistry, and FTIR Microspectroscopy

“…However, a semi-quantitative analysis on the density value of the immuno-stains shows less expression of p53 and CK5/6 in FFPE-tissues (Figures 3 and 4). Recently, concerns have been raised regarding the irreproducibility of the immunohistochemical data for studying prognostic features in OSCC [21,22]. The 8th edition of the American Joint Committee on Cancer (AJCC) staging has reinforced focus on histo-morphological prognostic features, such as tumor stroma ratio, depth of invasion, and extranodal extension, to study the prognosis of OSCC [22].…”