The role of worst pattern of invasion in the prognosis of oral cavity malignancies

Brett Campbell; Abhijit Gundale; Maximiliano Ramia de Cap; Sumedh Kaul; Ernest Gomez; Michiya Nishino; Scharukh Jalisi

doi:10.18203/issn.2454-5929.ijohns20250787

Authors

Brett Campbell Department of Surgery, Division of Otolaryngology, Beth Israel Medical Center, Boston, MA, USA
Abhijit Gundale Department of Otolaryngology-Head and Neck Surgery-McAlester Regional Health Center, McAlester, USA
Maximiliano Ramia de Cap Department of Pathology, Beth Israel Medical Center, Boston, MA, USA
Sumedh Kaul Department of Surgery, Beth Israel Deaconess Medical Center, Boston, USA
Ernest Gomez Department of Surgery, Division of Otolaryngology, Beth Israel Medical Center, Boston, MA, USA
Michiya Nishino Department of Pathology, Beth Israel Medical Center, Boston, MA, USA
Scharukh Jalisi Department of Surgery, Division of Otolaryngology, Beth Israel Medical Center, Boston, MA, USA

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20250787

Keywords:

Worst pattern of invasion, Oral cavity, Malignancy, Tongue cancer, Head and neck cancer

Abstract

Background: Our study aimed to assess the significance of worst pattern of invasion (WPOI) and its effect on survival in oral cavity squamous cell carcinoma (OCSCC).

Methods: This is a retrospective study of patients with OCSCC who underwent surgery. Univariate and bivariate analysis were used to analyze the association between WPOI and demographics, tumor characteristics and treatment. The association of WPOI with overall survival was evaluated.

Results: The 3-year OS was 77% for WPOI ≤4 and 70% for WPOI 5 (p=0.5). In the tongue subsite, the 3-year OS was 81% for WPOI ≤4 and 57% for WPOI 5 (p=0.08). WPOI-5 showed significant association with perineural invasion (p<0.01), lymphovascular invasion (p<0.01), lymph node involvement (p<0.03), and higher depth of invasion (p<0.01).

Conclusion: WPOI-5 may be considered a prognostic factor in deciding treatment in the post-surgical setting, and my become a mandatory parameter in pathology synoptic reports in the future.

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References

Almangush A, Mäkitie AA, Triantafyllou A. Staging and grading of oral squamous cell carcinoma: An update. Oral Oncol. 2020;107:104799. DOI: https://doi.org/10.1016/j.oraloncology.2020.104799

Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893-917. DOI: https://doi.org/10.1002/ijc.25516

Rajappa SK, Maheshwari U, Ram D. Early oral cavity cancer: The prognostic factors and impact of adjuvant radiation on survival. Head & Neck. 2019;41(10):3577-83. DOI: https://doi.org/10.1002/hed.25882

Sessions DG, Spector GJ, Lenox J, Haughey B, Chao C, Marks J. Analysis of Treatment Results for Oral Tongue Cancer: The Laryngoscope. 2002;112(4):616-25. DOI: https://doi.org/10.1097/00005537-200204000-00005

Brandwein-Gensler M, Smith RV, Wang B. Validation of the histologic risk model in a new cohort of patients with head and neck squamous cell carcinoma. American J Surg Pathol. 2010;34(5):676-88. DOI: https://doi.org/10.1097/PAS.0b013e3181d95c37

Adeoye J, Thomson P, Choi S. Prognostic significance of multi‐positive invasive histopathology in oral cancer. J Oral Pathol Med. 2020;49(10):1004-10. DOI: https://doi.org/10.1111/jop.13086

Chatterjee D, Bansal V, Malik V. Tumor budding and worse pattern of invasion can predict nodal metastasis in oral cancers and associated with poor survival in early-stage tumors. Ear Nose Throat J. 2019;98(7):112-9. DOI: https://doi.org/10.1177/0145561319848669

Amin MB, Greene FL. AJCC Cancer Staging Manual. 8th ed. 2017.

Sim YC, Hwang JH, Ahn KM. Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients. J Korean Assoc Oral Maxillofac Surg. 2019;45(2):83. DOI: https://doi.org/10.5125/jkaoms.2019.45.2.83

Cerezo L, Millán I, Torre A, Aragón G, Otero J. Prognostic factors for survival and tumor control in cervical lymph node metastases from head and neck cancer. A multivariate study of 492 cases. Cancer. 1992;69(5):1224-34. DOI: https://doi.org/10.1002/cncr.2820690526

Kramer S, Marcial VA, Pajak TF, MacLean CJ, Davis LW. Prognostic factors for loco/regional control and metastasis and the impact on survival. Int J Radiat Oncol Biol Phys. 1986;12(4):573-8. DOI: https://doi.org/10.1016/0360-3016(86)90065-9

Manjula BV, Augustine S, Selvam S, Mohan AM. Prognostic and Predictive Factors in Gingivo Buccal Complex Squamous Cell Carcinoma: Role of Tumor Budding and Pattern of Invasion. Indian J Otolaryngol Head Neck Surg. 2015;67(1):98-104. DOI: https://doi.org/10.1007/s12070-014-0787-2

Lundqvist L, Stenlund H, Laurell G, Nylander K. The importance of stromal inflammation in squamous cell carcinoma of the tongue: Stromal inflammation in tongue carcinoma. J Oral Pathol & Med. 2012;41(5):379-83. DOI: https://doi.org/10.1111/j.1600-0714.2011.01107.x

Kane SV, Gupta M, Kakade AC, D’ Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. EJSO. 2006;32(7):795-803. DOI: https://doi.org/10.1016/j.ejso.2006.05.004

Silva SD, Kowalski LP. Perineural invasion in oral cancer: challenges, controversies and clinical impact. Chin Clin Oncol. 2019;8(1):5-15. DOI: https://doi.org/10.21037/cco.2018.11.04

Binmadi NO, Basile JR. Perineural invasion in oral squamous cell carcinoma: A discussion of significance and review of the literature. Oral Oncol. 2011;47(11):1005-10. DOI: https://doi.org/10.1016/j.oraloncology.2011.08.002

Mishra A, Das A, Dhal I. Worst pattern of invasion in oral squamous cell carcinoma is an independent prognostic factor. J Oral Biol Craniofac Res. 2022;12(6):771-6. DOI: https://doi.org/10.1016/j.jobcr.2022.08.027

Spoerl S, Gerken M, Fischer R. Lymphatic and vascular invasion in oral squamous cell carcinoma: Implications for recurrence and survival in a population-based cohort study. Oral Oncol. 2020;111:105009. DOI: https://doi.org/10.1016/j.oraloncology.2020.105009

Marinelli LM, Chatzopoulos K, Marinelli JP. Clinicopathologic predictors of survival in buccal squamous cell carcinoma. J Oral Pathol Med. 2020;49(9):857-64. DOI: https://doi.org/10.1111/jop.13046

Almangush A, Bello IO, Keski–Säntti H. Depth of invasion, tumor budding, and worst pattern of invasion: Prognostic indicators in early‐stage oral tongue cancer. Head Neck. 2014;36(6):811-8. DOI: https://doi.org/10.1002/hed.23380

Li Y, Bai S, Carroll W. Validation of the risk model: high-risk classification and tumor pattern of invasion predict outcome for patients with low-stage oral cavity squamous cell carcinoma. Head and Neck Pathol. 2013;7(3):211-23. DOI: https://doi.org/10.1007/s12105-012-0412-1

Yue LE, Sharif KF, Sims JR. Oral squamous carcinoma: Aggressive tumor pattern of invasion predicts direct mandible invasion. Head & Neck. 2020;42(11):3171-8. DOI: https://doi.org/10.1002/hed.26360

Almangush A, Bello IO, Coletta RD. For early-stage oral tongue cancer, depth of invasion and worst pattern of invasion are the strongest pathological predictors for locoregional recurrence and mortality. Virchows Arch. 2015;467(1):39-46. DOI: https://doi.org/10.1007/s00428-015-1758-z