Pattern of invasion and margin assessment in patients with oral tongue cancer

Abstract

Background Involvement of resection margins and the pattern of tumor invasion are reported to be important predictors of local recurrence and survival in surgically treated patients. In this study we have retrospectively assessed the significance of these two prognostic factors in a relatively homogeneous patient population. Patients and Methods This study was confined to 150 previously untreated patients who had surgery for squamous carcinoma of the oral tongue between 1987 and 1993. There were 82 men and 68 women who ranged in age from 25 to 89 years (median 60 years). Glossectomy was peroral in 129, whereas 8 and 13, respectively, had a cheek flap or mandibulotomy approach. Some form of lymphadenectomy was performed in 109 (73%), and 51 patients (34%) received postoperative radiotherapy. Histologic slides from each primary tumor were reviewed to verify the margin status. In addition, the pattern of invasion was evaluated and graded from 1 to 4, varying from a consistently well‐defined, “pushing” border (Grade 1) to diffuse infiltration and cellular dissociation (Grade 4). Results Intraoperative frozen section assessment of margins was accurate, whether positive or negative, in 118 of 133 patients (89%). Positive or close margins (within one high‐power field) and an endophytic growth pattern were associated with a significant increase in local recurrence (p <0.003 and <0.04, respectively). With higher grades of infiltration (Grade 3 or 4; 82 patients), the tumors tended to be larger and the patients younger. Although the likelihood of nodal involvement and subsequent distant metastasis was significantly greater in those with Grade 3 or grade 4 patterns (p <0.0003 and <0.01, respectively), there was no impact on local recurrence. Cumulative survival was similar whether or not the surgical margins were involved, but was significantly reduced when the pattern of tumor invasion was of higher grade (p <0.01). Summary Frozen section provided reasonably accurate information about margins in our patients, whether taken from the patient or the surgical specimen. Positive margins increased the likelihood of local recurrence, but did not impact on survival because subsequent surgery and/or irradiation controlled tumor recurrence in some patients. Grade 3 or 4 patterns at the tumor/host interface were associated with an increased incidence of nodal and distant metastasis, as well as a significant decrease in survival. © 1999 John Wiley & Sons, Inc. Head Neck 21: 408–413, 1999.

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

“…The relationship between POI and the incidence of local recurrence has been reported by some researchers [6,8]. Brandwein-Gensler et al stated that the worst POI was associated with local recurrence, and this was because of the presence of tumor satellites with 1 mm or greater distance of intervening normal tissue at the tumor/host interface [8].…”

“…Although we did not examine the presence of tumor satellites at the tumor/host interface as stated by Brandwein-Gensler et al [8], this evaluation may be useful for the further assessment of local tumor control. On the other hand, Spiro et al reported that POI had a significant influence on survival, but not local recurrence [6]. Moreover, they concluded that patients with diffuse POI had a significant decrease in survival, presumably because they were more likely to be seen with nodal involvement [6].…”

“…Treatment failure in OTSCC patients is most frequently due to local and regional recurrences [4,5]. The prognosis also depends or varies with nodal involvement, tumor thickness, and the status of the surgical margins [4][5][6][7][8][9][10][11]. In particular, the most significant prognostic factor in OTSCC is the presence of metastatic disease in the cervical lymph nodes [7,9,11].…”

Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma

“…The reported risk of local failure in the presence of close margins in patients with oral SCC has been variously reported between 8.6% and 80% [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] (Table 4). We continue to lack a standardized treatment protocol with regard to close margins.…”

Prognostic Value of Frozen Section in T1, T2 Carcinoma of Oral Cavity

“…Spiro et al [22]. Reported that the presence of positive margins increased the likelihood of local recurrence but did not impact on survival since subsequent surgery and/or irradiation controlled tumor recurrence in some of their patients.…”