Beyond Depth of Invasion: Adverse Pathologic Tumor Features in Early Oral Tongue Squamous Cell Carcinoma

Abstract

Objective In small (≤2 cm) oral tongue squamous cell carcinoma (OTSCC), we sought to clarify the contribution of pathologic features including perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion‐5 (WPOI‐5) to clinical outcomes relative to tumor depth of invasion (DOI) of > or ≤ 4 mm. Methods Cases of ≤2 cm OTSCC treated surgically between 2000 and 2017 at an academic cancer center were reviewed, with retrospective pathologic slide review of DOI, LVI, PNI, and WPOI‐5. Primary outcome measures included occult nodal positivity, 2‐year locoregional recurrence (LRR), disease‐specific survival (DSS), and overall survival (OS). Results One hundred tumors were included in analyses; 50 had DOI ≤ 4 mm, while 50 had DOI > 4 mm. When DOI was ≤4 mm, the presence of PNI, LVI, or WPOI‐5 was not associated with higher rates of occult cervical metastasis, LRR, or OS. When DOI was >4 mm, there was no difference in rates of occult cervical metastasis or LRR with each feature. On multivariate analysis, only the presence of two or more adverse features was associated with higher LRR (OR 5.7, P = .01) and worse DSS (HR 6.5, P = .02). Conclusion The rate of occult cervical metastases in small (≤2 cm) OTSCC when DOI is ≤4 mm is very low even when PNI, LVI, or WPOI‐5 is present, and 2‐year LRR is no different. When DOI is >4 mm, the strongest predictor of recurrence and survival on multivariate analysis is the presence of two or more features in the tumor. Level of Evidence 4 Laryngoscope, 130:1715–1720, 2020

Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

“…51 However, Ebrahimi et al 52 have recently emphasized that depth alone (ie, in absence of other risk factors such as nodal metastasis or close margin) should not be used as an indication of postoperative radiotherapy in patients with a small OSCC. This is supported by the finding from another recent study 53 concluding that in case of a small oral tongue cancer (≤2 cm) with DOI > 4 mm, the presence of at least two adverse features (eg, perineural invasion and lymphovascular invasion) will warrant the consideration of adjuvant therapy. Indeed, multimodality treatment based on multiple adverse prognostic indicators is practically safer than a treatment decision based on a single parameter.…”

Stromal categorization in early oral tongue cancer

“…We noted that the combination score has a prognostic value superior to each of the single parameters separately (Table 1). Importantly, identification of aggressive early OTSCC based on two adverse prognosticators is obviously more warranted than relying on a single prognosticator [30].…”

Machine learning and treatment outcome prediction for oral cancer

“…In recent years, demographic, clinicopathological, therapeutic and bio‐molecular data have all been used to populate clinical decision‐making tools, including statistical regression models and prognostic nomograms, in an attempt to predict poor clinical outcome post‐OSCC treatment. Unfortunately, such methods have gained limited acceptance in contemporary clinical practice due to data validity concerns and little demonstrable predictive accuracy 3‐12 …”