High‐risk early‐stage oral tongue squamous cell carcinoma, when free margins are not enough: Critical review

Abstract

Oral tongue squamous cell carcinoma (OTSCC) is a quite peculiar disease from an anatomical and biological standpoint. An increasing amount of literature highlights the existence of a small subset of T1‐T2N0 OTSCC, properly resected on a margin‐dependent basis, which conversely proved higher than expected rates of loco‐regional/distant failure and disease‐specific mortality. These specific high‐risk tumors might not have a margin‐dependent disease and could possibly benefit from a more aggressive upfront loco‐regional treatment, especially addressing the so‐called T‐N tract. Widespread adoption of a histopathological risk model would allow early recognition of these high‐risk diseases and, consequently, intensification of the traditional treatment strategies in that specific niche. We reviewed the available knowledge trying to shed light on the potential determinants of the dismal prognosis of these high‐risk OTSCC, with special reference to the role of overlooked T‐N tract involvement and possible alternatives in terms of elective neck management and risk stratification.

The Impact of Histopathological Features on the Prognosis of Oral Squamous Cell Carcinoma: A Comprehensive Review and Meta-Analysis

“…The therapeutic plan and the estimation of prognosis for OSCC patients still rely on the disease stage, but it does not appropriately reflect the biological behavior of this heterogeneous group of tumors. Even at an early stage, specifically tumors of the tongue and floor of mouth may be very aggressive, with increased tendency to invasion, metastasis, and consequently poor prognosis ( 6 ). Many different biomarkers have been proposed as prognostic indicators for OSCC, and among those are specific histopathological features of the tumors.…”

Single-cell transcriptome and TCR profiling revealed the immunosuppression caused by Macrophages and T cells in the chemoresistant oral tongue squamous cell carcinoma

“…Historically, surgical therapy combined with chemo(radio)therapy has been the treatment of preference for patients. However, over 25% of OTSCC patients did not bene t from this multimodal treatment, which increased the risk of tumor relapse [39]. Thus, increasing response e cacy and identifying targeted biomarkers continue to be the most signi cant challenges for postoperative drug therapy.…”

The Holistic Review on Occurrence, Biology, Diagnosis, and Treatment of Oral Squamous Cell Carcinoma

“…In a crucial study, the criteria for exclusion of studies included -alternative tumors other than OSCC [49], samples that contained biopsies [50,51], immunohistochemistry-based investigations [51], histological grading systems used for analysis [52], reports of univariate survival analysis [53], studies based solely on association analysis [54], omitted the hazards for OS (HR) and/or its 95% confidence interval (CI), and reviews of associated literature [55], conference abstracts and letters [56]. During the title and abstract screening, 2490 research were included.…”