How pathological criteria can impact prognosis of tongue and floor of the mouth squamous cell carcinoma

Rodrigues, Renata Miranda; Bernardo, Vagner Gonçalves; Silva, Sabrina Daniela da; Camisasca, Danielle Resende; Faria, P.A.; Dias, Fernando Luiz; Pinto, Luís Felipe Ribeiro; Albano, Rodolpho Mattos; Bergmann, Anke; Lourenço, Simone de Queiroz Chaves

doi:10.1590/1678-7757-2019-0198

Cited by 13 publications

(15 citation statements)

References 28 publications

(34 reference statements)

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“…In the present study, we found that the presence of high-grade histology was strongly associated with advanced T stage, neck lymph node metastasis, and extranodal spread, which subsequently contributed to advanced stage and prevalent recurrence. Similar conclusions have been deduced in previous research [ 12 – 18 ]. Kademani et al presented 10-year survival among three different histological grade OSCCs in 233 patients, and their results were similar to those of our study [ 12 ].…”

Section: Discussionsupporting

confidence: 93%

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Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study

2020

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The TNM staging system for oral squamous cell carcinoma (OSCC) provides clinicians a dependable foundation for patient prognosis and management decisions, but in clinical practice, treatment outcomes of patients with OSCC are sometimes unsatisfactory. This retrospective study investigated the association between survival and clinicopathological characteristics and histological grades of 2535 patients with OSCC. Additionally, the present study aimed to compare the predictive abilities of histological grades with other common prognostic factors. The enrolled patients were divided into three groups by two experienced pathologists into well-differentiated, moderately differentiated, and poorly differentiated groups, according to the WHO classification. Finally, we designed an observational, retrospective study based on the histological grading of tumors to compare their clinicopathological characteristics and conducted survival analysis among the three groups. Advanced tumor stage was diagnosed in 23.9%, 44.0%, and 55.1% of patients with grades 1-3 OSCC, respectively. By T status, T3 or T4 tumors were found in approximately 22%, 34%, and 40% of patients with grades 1-3 OSCC, respectively. By N status, lymph node metastases were found in 6.1%, 29.3%, and 45.9% of patients with grades 1-3 OSCC, respectively. Thus, significant survival differences were observed based on different OSCC histological grades. Meanwhile, in the multivariate (adjusted) analysis, N1 and N2 stages, extranodal spread, and poor differentiation were associated with a higher recurrence risk than the other common prognostic factors. In conclusion, 5% of patients in our study presented with poorly differentiated OSCC at diagnosis. Furthermore, grade 3 OSCC has worse prognosis and is more aggressive than grades 1 and 2 OSCC. In the future, we should focus on modifying individual therapy for poorly differentiated OSCC to achieve improved outcomes.

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Section: Discussionsupporting

confidence: 93%

“…Several studies have indicated that patients with grade 3 OSCC are more likely to present with neck lymph node metastasis and be associated with decreased survival as compared to the PLOS ONE patients with other tumor grades [12][13][14][15][16][17][18][19]. However, the sample sizes of these studies were not as large as that in our study.…”

Section: Discussioncontrasting

confidence: 79%

Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study

2020

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“…The number of mitoses at both sites (surface and invasion front) reviewed and analyzed as exact number and coded as a score was not a suitable value to predict or estimate any outcome parameter. This finding corresponds to previous observations [17,23,28], though a high mitotic activity is seen as a surrogate marker for poorly differentiated tumors associated with poor prognosis [29].…”

Section: Number Of Mitosessupporting

confidence: 92%

Staging more important than grading? Evaluation of malignancy grading, depth of invasion, and resection margins in oral squamous cell carcinoma

et al. 2020

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Objectives The present study evaluated the predictive value of staging and grading parameters concerning the presence of lymph-node metastases, overall survival (OS), and relapse-free survival (RFS) of patients with oral squamous cell carcinoma (OSCC). Materials and methods HE-stains of 135 surgically treated (R0) primary OSCCs were analyzed using a both microscopic and software-based approach. Depth of invasion (DOI) and resection margins (RM) were measured, and each case was graded according to the malignancy grading system as described by Anneroth et al. and Bryne et al. on two different sites of the tumor (surface and invasion front; TS and IF). Results Parameters that could be identified as significant predictors of OS and RFS were UICC cancer stage (p = 0.009 and p = 0.012); pT-stage as defined in the 7th edition (p = 0.029 and 0.015) and, after restaging using DOI, 8th edition (p = 0.023 and p = 0.005) of the TNM classification of malignant tumors; the presence of lymphonodular metastases (LM) (p = 0.004 and p = 0.011); degree of keratinization (p = 0.029 and p = 0.042); and pattern of growth (p = 0.029 and p = 0.024) at the TS after applying a binary scale for both parameters. Also, when directly comparing the most extreme subgroups (scores 1 and 4) of lymphoplasmacytic infiltration at the IF, there was a significant difference in OS (p = 0.046) and RFS (p = 0.005). Invasion of blood vessels (p = 0.013) and perineural invasion (p = 0.023) were significantly associated with a lower OS. Age lower than 60 years (univariate p = 0.029, multivariate p = 0.031), infiltration of lymphatic vessels (p = 0.003), infiltration of nerves (p = 0.010), pT-stage (8th edition) (p = 0.014), degree of keratinization at the IF (p = 0.033), and nuclear polymorphism at the IF (p = 0.043) after conversion to a binary scale were found to be significant prognostic parameters regarding the presence of LM. DOI evolved as a significant predictor for OS (p = 0.006), RFS (p = 0.003), and LM (p = 0.032) in metric and grouped analysis. Conclusions The current evaluation revealed depth of invasion as strongest histologic predictor of metastatic tumor growth, overall survival, and relapse-free survival in OSCC, confirming the current adaption of the T-classification. Other distinct histologic grading parameters investigated during this study can give valuable indications of a tumor’s potential aggressiveness, but the exact site, mode, and procedure need further exploration. Clinical relevance Integrating measurement of DOI also into the pretherapeutic staging process could aid in treatment planning.

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“…9 More evidence shows that grade might affect the prognosis and management of oral cavity SCC. [10][11][12] Some have proposed that significant improvement in prognosis of sinonasal malignancies will likely depend on histologyspecific directed treatment regimens. 5 However, due to the rarity of sinonasal SCC, epidemiological and prognostic conclusions regarding histological subtypes and differentiation are difficult to determine.…”

Section: Introductionmentioning

confidence: 99%

Survival Outcomes in Sinonasal Poorly Differentiated Squamous Cell Carcinoma

et al. 2020

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Objective: Sinonasal squamous cell carcinoma (SCC) is rare with no consensus on treatment regimen. Our goal is to analyze treatment outcomes in poorly differentiated SCC (PDSCC) using a large national database. Study Design: Retrospective database study. Methods: The National Cancer Database was queried for sinonasal invasive SCC, grade 3 (poorly differentiated) from 2004 to 2014. Patient demographics and tumor and treatment characteristics were tabulated. Kaplan-Meier (KM) analysis was performed to compare overall survival (OS) between histology subtype and primary site. Multivariable Cox proportional hazards regression was performed for statistical analysis of treatment regimen on OS. Results: A total of 1,074 patients were identified. The maxillary sinus was the most common site (45%). T4 tumors were observed in 50% of patients, with most patients treated at high-volume facilities (77%). In KM analysis, spindle cell SCC histological subtype, primary tumors of the maxillary sinus, and poorly differentiated grade had worse OS. In our Cox-PH model, higher T stage and age were associated with worse OS. Those treated at a high-volume facility and those who underwent surgical resection followed by adjuvant radiation had improved OS. Chemotherapy within the treatment regimen did not confer survival benefit except in surgical patients when positive margins were present, and surgery with adjuvant chemoradiation trended toward improved survival. Conclusions: Sinonasal PDSCC appears to be best treated at high-volume centers with surgical resection followed by adjuvant radiation. Poorly differentiated grade has worse OS compared to more differentiated tumors. Chemotherapy along with adjuvant radiation may have a role in patients with positive surgical margins.

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How pathological criteria can impact prognosis of tongue and floor of the mouth squamous cell carcinoma

Cited by 13 publications

References 28 publications

Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study

Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study

Staging more important than grading? Evaluation of malignancy grading, depth of invasion, and resection margins in oral squamous cell carcinoma

Survival Outcomes in Sinonasal Poorly Differentiated Squamous Cell Carcinoma

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