Worst pattern of invasion and other histopathological features in oral cancer as determinants of prognosis and survival rate: A retrospective cohort analysis

Abstract

Oral cavity squamous cell carcinoma (OCSCC) is a well-recognized malignancy of the head and neck. Studies on patients with early-stage oral cancer have shown that they develop locally recurring and/or regional lymph node metastasis, which results in disease-associated mortality. Thus, early-stage oral cancer does not always present good prognoses. The present study aimed to determine the efficacy of using worst pattern of invasion (WPOI) and other histopathological features, such as prognostic factors in OCSCC, and analyze the impact of resection margin status and histopathological prognostic indicators on local recurrence (LR) and overall survival (OS) in patients with OCSCC. A retrospective cohort study was conducted by reviewing the charts of 63 patients with OCSCC treated with primary surgery at King Abdulaziz University Hospital between 2012 and 2019. An author and an experienced pathologist reviewed pathology slides. Associations of histopathological factors, including differentiation, stage, lymphovascular invasion, extracapsular extension, perineural invasion (PNI), WPOI and surgical margins, with LR or disease-free survival (DFS) were evaluated. Univariate analysis identified WPOI and PNI, and multivariate analysis identified the WPOI as predictive factors for LR and DFS. Kaplan-Meier analysis identified the WPOI and PNI as predictive factors for OS and WPOI as a predictive factor for DFS. Therefore, it may be concluded that WPOI and PNI are significant independent prognostic factors for local tumor control and DFS in patients with OCSCC.

Evaluating depth of invasion across oral cavity subsites as part of the AJCC 8th edition T staging criteria for oral cavity squamous cell carcinoma

“…These variables included age, sex, race, Charlson-Deyo comorbidity score, median census-tract income, insurance status, tumor size, pathologic N status, presence of lymphovascular invasion, extracapsular extension, adjuvant chemotherapy and/or radiation use, neck dissection surgery, and surgical margin positivity. 3,18 Analysis for the overall cohort also included adjustment on primary oral cavity subsite. A case complete approach was used to address any potential missing data.…”

“…Multivariable‐adjusted Cox proportional hazards analyses were performed to control for variables determined a priori that would most likely act as confounders. These variables included age, sex, race, Charlson–Deyo comorbidity score, median census‐tract income, insurance status, tumor size, pathologic N status, presence of lymphovascular invasion, extracapsular extension, adjuvant chemotherapy and/or radiation use, neck dissection surgery, and surgical margin positivity 3,18 . Analysis for the overall cohort also included adjustment on primary oral cavity subsite.…”

Analysis of lymphocytic infiltrate as a predictive factor of neck metastases in oral squamous cell carcinoma

“…DOI represents one of the most important prognostic parameters for the appearance of neck metastases in OSCC. In numerous analyses, DOI is an independent prognostic factor that is associated with tumor size, especially in patients with T1-T2 stage 22 . A study that included 161 patients with OSCC and clinical N0 findings in the neck indicated a correlation between DOI andmetastases in the regional lymph nodes of the neck 23 .…”

“…DOI predstavlja jedan od važnijih prognostičkih parametara pojave metastaza na vratu kod OSCC-a. U mnogobrojnim analizama DOI predstavlja nezavisni prognostički faktor koji je povezan sa veličinom tumora, naročito kod pacijenata sa T1-T2 stadijumom 22 . Istraživanje koje je obuhvatilo 161 pacijenata sa OPK-om i kliničkim N0 nalazom na vratu ukazalo je na postojanje korelacije između DOI i pojave metastaza u regionalnim limfnim nodusima vrata 23 .…”