Histopathologic prognostic indices in tongue squamous cell carcinoma (original) (raw)
Related papers
Cancers review, 2014
Background. There is limited data on adjuvant treatment following surgery in patients with squamous cell carcinoma of the oral tongue. Aims. This retrospective study investigates prognostic value of different factors for local relapse-free survival (LRFS), regional relapse-free survival (RRFS), disease-free survival (DFS), and overall survival (OS) in patients with oral tongue cancer treated with adjuvant therapy following surgery. Materials and methods. Forty six patients with surgically treated oral tongue cancer were enrolled in the analysis. Adjuvant therapy consisted of postoperative radiotherapy (PO-RT) or postoperative concurrent chemoradiotherapy (PO-CCRT). All patients received three dimensional conformal radiotherapy. Weekly cisplatin was given as concurrent chemotherapy. Identification of prognostic factors for survival was done with univariate analysis. Multivariate analysis was used for factors confirmed as significant on univariate analysis. Results. Independent prognostic factors negatively influencing LRFS, DFS, and OS were ECOG performance status (p = 0.002, p = 0.013 and p = 0.022, respectively), overall stage (p = 0.011, p = 0.010 and p = 0.009, respectively), and pathologic nodal classification (p = 0.016, p = 0.011 and p = 0.015, respectively). Surgical margin status was an independent prognostic factor for RRFS, DFS, and OS (p = 0.032, p = 0.027 and p = 0.028, respectively). The type of adjuvant treatment used was independently prognostic for lower rates of LRFS and DFS (p = 0.029 and p = 0.010, respectively). Conclusions. Positive postoperative nodal status and close or positive resection margins had the most prominent negative prognostic influence on patients' survival.
Radiation Oncology Journal
There is sparse literature on treatment outcomes research on resectable oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to measure the treatment outcomes, explore the failure patterns, and identify the potential clinicopathological prognostic factors affecting treatment outcomes for resectable OTSCC. Materials and Methods: It is a retrospective analysis of 202 patients with resectable OTSCC who underwent upfront primary surgical resection followed by adjuvant radiotherapy with or without concurrent chemotherapy if indicated. Results: The median follow-up was 35.2 months (range, 1.2 to 99.9 months). The median duration of locoregional control (LRC) was 84.9 months (95% confidence interval, 67.3-102.4). The 3-and 5-year LRC rate was 68.5% and 58.3%, respectively. Multivariate analysis showed that increasing pT stage, increasing pN stage, and the presence of extracapsular extension (ECE) were significantly associated with poorer LRC. The median duration of overall survival (OS) was not reached at the time of analysis. The 3-and 5-year OS rate was 70.5% and 66.6%, respectively. Multivariate analysis showed that increasing pT stage and the presence of ECE were significantly associated with a poorer OS. Conclusion: Locoregional failure remains the main cause of treatment failure in resectable OTSCC. There is scope to further improve prognosis considering modest LRC and OS. Pathological T-stage, N-stage, and ECE are strong prognostic factors. Further research is required to confirm whether adjuvant therapy adds to treatment outcomes in cases with lymphovascular invasion, perineural invasion, and depth of invasion, and help clinicians tailoring adjuvant therapy.
Acta Otorhinolaryngologica Italica, 2019
Early and loco-regionally advanced oral tongue squamous cell carcinoma (OTSCC) can be treated by surgery alone or followed by adjuvant radiotherapy or chemoradiotherapy. Nevertheless, up to 40% of patients develop tumour relapse. The aim of our study is to investigate the clinical and pathological features associated with reduced disease-free survival (DFS) in a cohort of surgically-resected OTSCC patients. One hundred and six patients surgically resected for OTSCC were retrospectively identified from clinical records. DFS was calculated according to the Kaplan-Meier method and differences between variables were assessed with Log-Rank test. A multivariable Cox regression model was used to analyse the impact of different prognostic factors on DFS. After a median of follow-up of 8.9 years, 22 events, including 11 deaths, were observed. Overall, the 5-year DFS-rate was 87.4%. The presence of extra-nodal extension (p = 0.023) and perineural invasion (p = 0.003) were significantly correlated with shorter DFS (in univariate analysis). In multivariable analysis, extra-nodal extension and perineural invasion confirmed their role as independent prognostic factors associated with an increased risk of disease recurrence [hazard ratio (HR) 2.87, 95% CI 1.11-7.42, p = 0.03; HR 3.85, 95% CI 1.49-9.96, p = 0.006, respectively]. p16 and p53 expressions in tumour cells were detected in 12% (n = 9) and 46% (n = 40) of cases, respectively. No differences in DFS were observed between p16+ and p16-(p = 0.125) and between p53+ and p53-tumours (p = 0.213). In conclusion, radical surgery, eventually followed by adjuvant radiotherapy or chemo-radiotherapy, can achieve high cure rates in OTSCC. After long-term follow-up, perineural invasion and extra-nodal extension confirmed their role as prognostic factors associated with reduced DFS in OTSCC patients. KEY WORDS: Oral cancer • Tongue cancer • Head and neck squamous cell carcinoma • p53 • p16 RIASSUNTO Il tumore della lingua mobile, in fase iniziale o localmente avanzata, può essere trattato mediante chirurgia, da sola o seguita da radioterapia o chemio-radioterapia. Tuttavia, fino al 40% dei pazienti sviluppa una recidiva di malattia. Lo scopo del nostro studio è quello di valutare le caratteristiche anatomo-patologiche e cliniche associate ad una ridotta sopravvivenza libera da malattia (DFS) in pazienti con tumore della lingua mobile sottoposti a chirurgia. Sono stati identificati 106 pazienti operati per tumore della lingua mobile. Dopo un follow-up mediano di 8,9 anni, sono stati osservati 22 eventi, incluse 11 morti. Il tasso di DFS a 5 anni è stato dell'87,4%. La presenza di estensione extranodale (p = 0,023) ed invasione perineurale (p = 0,003) erano significativamente correlate ad una DFS ridotta (analisi univariata). Nell'analisi multivariata, sia l'estensione extranodale che l'invasione perineurale hanno confermato il loro ruolo quali fattori prognostici associati ad un aumentato rischio di recidiva di malattia [Hazard Ratio (HR) 2,
Prognostic significance of lymph node density in squamous cell carcinoma of the tongue
Head & Neck, 2015
Background. Lymph node density (LND) is more useful than the TNM classification in predicting survival after surgery for many cancers. The purpose of this study was to clarify independent prognostic factors for hypopharyngeal squamous cell carcinoma (HPSCC) and broaden the staging system to improve its predictive value. Methods. The present study included 105 patients with HPSCC treated with hypophagectomy and neck dissection between 1993 and 2014. Results. The median LND in patients with HPSCC was 0.060 (range 0.026-0.620). We found a significant difference in LND values between patients with and without recurrence (0.063 vs. 0.030, respectively; p = 0.001). The cutoff value of LND for recurrence was 0.055, with a sensitivity of 68% and specificity of 71%. Cervical lymph node metastasis, advanced pathologic T stage, lymphovascular invasion, LND C0.055, and extracapsular spread had significant adverse effects on 5-year overall and disease-specific survival in a univariate analysis. Multivariate analysis confirmed a significant association between 5-year overall survival and LND C0.055 [hazard ratio (HR) 2.19; 95% confidence interval (CI) 1.06-4.51; p = 0.035] and extracapsular spread (HR 2.47; 95% CI 1.09-5.61; p = 0.030). Furthermore, LND C0.055 (HR 2.30; 95% CI 1.07-4.93; p = 0.034) and extracapsular spread (HR 2.95; 95% CI 1.20-7.29; p = 0.019) were associated with 5year, disease-specific survival. Conclusions. The median LND cutoff values C0.055 are associated with a greater risk of recurrence and survival in patients with HPSCC.
Predictors of prognosis for squamous cell carcinoma of oral tongue
Journal of Surgical Oncology, 2014
Background and Objectives: Certain tumor-related factors like thickness increases the risk of nodal metastasis and may affect survival in patients with oral tongue cancers. The objective of this study is to identify those tumor-related prognostic predictors that can potentially influence decision for adjuvant radiotherapy. Methods: A retrospective review of all patients with oral tongue cancers treated primarily by surgery at Tata Memorial Hospital between January 2007 and June 2010. The demographic and commonly reported histopathological features were analyzed for their influence on disease free and overall survival. Results: Five hundred eighty-six patients were eligible for the study, of which 416 were males and 117 were females. Follow-up details were available for 498 (85%) patients with a median follow-up of 18 months and mean follow-up of 22 months. There were 302 patients who were alive and disease free at the last follow-up. This group had a mean follow-up of 27 months and median follow-up of 27.5 months. Disease recurrences during follow-up were observed in 184 (31%) patients. Sixty-one patients died subsequently. Perineural invasion significantly affected disease free survival (DFS). A tumor thickness of more than 11 mm significantly affected the overall survival (OS). Conclusion: Other than nodal metastasis, tumor-related factors like thickness and perineural invasion are adverse prognostic factors and can influence survival. These patients, especially in case of early stage cancers, may potentially benefit from postoperative adjuvant radiotherapy. Level of Evidence: 2b.
Journal of Cancer Research and Therapeutics, 2021
Background: Tongue carcinomas account for 25%-40% of intraoral squamous cell carcinomas (OSCCs). Although TNM staging systems is an international standard for cancer reporting, prognosis evaluation, and treatment planning, multiple histopathological risk assessment predictors such as tumor thickness (TT), tumor shape, tumor growth pattern, and invasive malignancy grading scoring systems have been studied and should form a basis for prediction and prognostication of such aggressive carcinomas. Aim: To evaluate and characterize the histomorphological prognostic indicators in OSCCs of tongue and compare it with OSCCs of other anatomic sites within the oral cavity. Furthermore, to elucidate the significance of histopathological indicators in predicting prognosis of tongue squamous cell carcinomas (SCCs). Materials and Methods: Forty SCC cases with 20 each of tongue and 20 from other intraoral sites were retrieved from department archives. Clinical data and staging were obtained for each case. Histomorphological parameters including pattern of invasion (POI), tumor budding (TB), depth of invasion (DOI), TT, lymphocytic host response, tumor-associated tissue eosinophilia (TATE), vascular invasion, perineural invasion (PNI), and muscular invasion were assessed. The results were statistically evaluated. Results: TB, DOI, and sarcolemmal spread were significant histologic predictors in tongue SCC. Upon correlation of histomorphological parameters with clinical staging, TT, POI, and TATE were observed to be significantly correlated (P ≤ 0.05). Conclusion: The histomorphological risk assessment model may serve as important addition to the existing prognosticators and may be used as a prognostic index to help plan and individualize treatment protocol in cases with aggressive high-risk disease for whom the use of multimodality treatment seems beneficial.
Analysis of Risk Factors of Predictive Local Tumor Control in Oral Cavity Cancer
Annals of Surgical Oncology, 2008
Background: Survival in oral cavity squamous cell carcinoma (OSCC) depends heavily on locoregional control. In this study, we sought to determine the independent prognosticators for local tumor control, disease-specific survival (DSS), and overall survival (OS) rates in a series of OSCC patients undergoing radical surgery.
Parameters and outcomes in 525 patients operated on for oral squamous cell carcinoma
Journal of Cranio-Maxillofacial Surgery, 2016
This report analyzed the outcomes of patients undergoing surgery fororal squamous cell carcinoma (OSCC) to identify the value ofprognostic factors. Material and methods A total of 525 patients were studied who had undergone surgery for oral squamous cell carcinoma (OSCC) between 2000 and 2011, of whom 222 had received postoperative radiation-therapy (PORT) and or chemoradiation-therapy (PORTC). For each patient, personal data, histological findings, treatment and outcome were recorded and analyzed statistically. Survival curves were calculated using the Kaplan-Meier algorithm, and the difference in survival among subgroups was examined. Results The overall survival (OS) and disease-specific survival (DSS) 5-year survival rate in the 525 patients were respectively 71.38% and 73.18%. The differences in the overall survival and diseasespecific 5-year survival were significant (p < 0.05) for age < 40 years, site of origin, N status, staging, grading, osseous medullar infiltration, and perineural invasion. In patients undergoing radiation therapy, only perineural invasion negatively influenced the survival prognosis. In 150 pT1 cases of tongue and floor-of-mouth cancer, an infiltration depth (ID) > 4 mm was statistically correlated with poorer prognosis. Conclusions The results demonstrate an improvement in the 5-year OS and DSS rates during the past decade compared with the previous decade.Univariate analysis revealed that age, tumor staging, and lymph node involvement, extracapsular spread, grading, perineurial invasion, infiltration depth, and osseus medullary invasion were associated significantly with overall survival and disease-specific survival.