Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features

Nur, Mutaz Mohammed; Saadi, Maimuna Al; O’Regan, Esther; Harten, Maria Van; Toner, Mary

doi:10.1007/s12105-020-01218-z

Cited by 8 publications

(19 citation statements)

References 21 publications

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“…After this thorough screening process, we agreed to include 18 studies involving 3954 patients in our qualitative and quantitative synthesis. 1–5,8,10–12,17–25 The study flow diagram of the selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Impact of worst pattern of invasion on prognosis of oral squamous cell carcinoma: a systematic review and meta-analysis

Binmadi,

Mohamed

2023

J Int Med Res

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Objective The relationship between the worst pattern of invasion (WPOI) and the prognosis of oral squamous cell carcinoma (OSCC) remains controversial. This systematic review and meta-analysis was performed to determine the impact of the WPOI on the prognosis of OSCC. Methods Studies from six databases were assessed for quality using the Newcastle–Ottawa Scale, and data were analyzed using Stata software. Results Eighteen studies involving 3954 patients showed that patients with a WPOI of 4 to 5 had significantly worse overall survival, disease-specific survival, and disease-free survival than patients with a WPOI of 1 to 3. Significant associations of the WPOI with locoregional recurrence and mortality were found. Conclusion A higher WPOI was significantly associated with a worse prognosis of OSCC across various outcomes. Incorporating the WPOI into standard histopathological assessments may guide personalized treatments and improve outcomes.

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Section: Resultsmentioning

confidence: 99%

Impact of worst pattern of invasion on prognosis of oral squamous cell carcinoma: a systematic review and meta-analysis

Binmadi,

Mohamed

2023

J Int Med Res

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“…The initial point-based grading system for WPOI was proposed by Jakobsson et al 25 and was later modified into 4 patterns by Anneroth et al 26 and Bayne et al 27 In 2005, Brandwein-Gensler and colleagues expanded the definition of WPOI by introducing WPOI-5, which was found to be an independent prognostic factor for local recurrence and survival 2,3,10,14 . Nevertheless, the frequency of WPOI-5 was low (10.3% in Xu and colleagues’ study), especially in early T-stage OSCCs (4.9% in Nur and colleagues), and it alone cannot identify all cases with adverse outcomes 3,28 . To improve the correlation of WPOI and prognosis, WPOI-4 was included in Brandwein-Gensler et al’s 14 Histological Risk Model, as it correlated with a significantly higher recurrence and lower DFS than nonaggressive WPOI≤3.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,10,14 Nevertheless, the frequency of WPOI-5 was low (10.3% in Xu and colleagues' study), especially in early T-stage OSCCs (4.9% in Nur and colleagues), and it alone cannot identify all cases with adverse outcomes. 3,28 To improve the correlation of WPOI and prognosis, WPOI-4 was included in Brandwein-Gensler et al's 14 Histological Risk Model, as it correlated with a significantly higher recurrence and lower DFS than nonaggressive WPOI ≤ 3. However, the definition of WPOI-4, presence of small tumor islands comprising ≤ 15 tumor cells per island, overlaps with that of tumor budding, which may result in a potential for impact and bias in evaluating the predictive effects of both factors.…”

Section: Discussionmentioning

confidence: 99%

New Histopathologic Risk Model for Early T-stage Oral Squamous Cell Carcinoma

Chang,

Hang,

Kuo

2023

American Journal of Surgical Pathology

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Oral squamous cell carcinoma (OSCC) is treated based on the TNM staging. However, early T-stage OSCC still exhibits substantial nodal metastasis and death rates. Recent literature highlights the independent prognostic value of worst pattern of invasion (WPOI) and tumor budding in OSCC. Nevertheless, WPOI-5 is uncommon in early T-stage OSCC, and the definitions of tumor budding and WPOI-4 overlap. Moreover, WPOI assessment is subjective, and tumor budding evaluation varies across studies. To address these limitations, we aimed to develop a modified WPOI system and a novel tumor budding scoring system that assesses single cells and high-density tumor budding. We also evaluated a new histopathologic risk model for early T-stage OSCC. The study cohort comprised 37 pT1 and 64 pT2 OSCCs. The modified WPOI demonstrated superior interobserver agreement compared with the original system (κ value: 0.98 vs. 0.53). In the multivariate analysis, modified WPOI and tumor budding score were independent prognostic factors for nodal metastasis and disease-free survival, while modified WPOI predicted disease-specific survival. By integrating these factors, our risk model stratified the patients into 3 groups. Notably, the intermediate-risk and high-risk groups exhibited significantly higher rates of nodal metastasis, recurrence, and tumor-related death. Conversely, none in the low-risk group had nodal metastasis or succumbed to the disease. Our model offered simplified scoring and potentially improved prognostic predictions. In conclusion, we’ve developed a modified WPOI system, a new tumor budding scoring system, and a reliable risk model that classifies early T-stage OSCC patients into distinct risk groups with significant prognostic differences.

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“…Statistically significant associations between PNI location with tumor size and cervical lymph node metastasis were also observed, which is in agreement with previous reports ( 4 , 10 , 12 , 13 , 15 , 21 ). One of the proposed explanations for this relationship, is that as tumor thickness increases, the invasion of lymph vessels and nerve fibers located in the submucosa is facilitated ( 24 ). PNI results from nerve-tumor crosstalk, a complex biological interaction that promotes neurogenesis, tumor proliferation and invasion, and both PNI and lymphovascular invasion share the activation of similar signaling pathways, where neurotropic factors, chemokines and other biomolecules are secreted towards the perineural niche and the tumor microenvironment ( 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Perineural invasion predicts poor survival and cervical lymph node metastasis in oral squamous cell carcinoma

Martínez-Flores,

Gómez-Soto,

Lozano-Burgos

et al. 2023

Med Oral

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Background Oral squamous cell carcinoma (OSCC) usually invades peripheral nerves through a process known as perineural invasion (PNI), recognized as an adverse factor considered for the administration of postoperative adjuvant therapy. The aim of this study was to assess the impact of PNI on survival and cervical lymph node metastasis in a cohort of OSCC patients. Material and Methods Presence, location and extension of PNI were assessed in a cohort of 57 paraffin-embedded OSCC resections. Clinico-pathological variables were obtained from each case. Five-year overall survival (OS) and 5-year disease-specific survival (DSS) curves were constructed according to the Kaplan-Meier method and compared with log-rank test. The Cox proportional hazard model was used to assess the role of PNI as an independent risk factor related to poor survival, and a binary logistic regression was performed to estimate the predictive value of PNI for regional lymph node metastasis. Results PNI was observed in 49.1% of the cases, affecting only small nerves. Peritumoral PNI was the most common location, and multifocal PNI the most frequent extent. Most PNI positive cases had cervical metastasis ( p =0.001), and PNI was more frequent in stages III-IV than in I-II ( p =0.02). The five-year OS and the 5-year DSS decreased in PNI positive and peritumoral PNI cases. PNI was an independent risk factor for poor 5-year OS and poor 5-year DSS. The odds for cervical lymph node metastasis were of 6.076 ( p =0.006) and 10.257 ( p =0.007) for PNI and Tumor budding (TB) positive cases, respectively. Conclusions PNI is a frequent finding in OSCC and an independent risk factor for poor OS and DSS. PNI and TB are both risk factors associated to an increased likelihood for the development of lymph node metastasis. Therefore, we suggest further investigations to test the combined PNI-TB scoring system in risk stratification models for OSCC. Key words: Perineural invasion, tumor budding, oral squamous cell carcinoma, survival, linfonodal metastasis.

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Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features

Cited by 8 publications

References 21 publications

Impact of worst pattern of invasion on prognosis of oral squamous cell carcinoma: a systematic review and meta-analysis

Impact of worst pattern of invasion on prognosis of oral squamous cell carcinoma: a systematic review and meta-analysis

New Histopathologic Risk Model for Early T-stage Oral Squamous Cell Carcinoma

Perineural invasion predicts poor survival and cervical lymph node metastasis in oral squamous cell carcinoma

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