Prognostic factors in mobile tongue and floor of mouth carcinoma

Abstract

This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the anterior tongue and floor of mouth.

Prognostic Factors for Local Control and Survival of Cancer of the Oral Tongue a retrospective analysis of 230 cases in Western Sweden

“…Nor did histological differentiation have any prognostic impact, in contrast to what others have found (7, 8). Several authors have shown that tumour thickness in mm (9-1 1) and perineural infiltration (10,12,13) determined from a histological specimen, are significantly correlated with prognosis. However, to make use of these findings, planned treatment with radical surgery would have to be done without knowing the result.…”

Invasion characteristics of oral tongue cancer

“…Although the evidence is not entirely consistent across studies, on balance supports, it the importance of measuring DI and assessing LVI and PNI as part of the histologic workup for patients with newly diagnosed tongue cancer. [9][10][11][12][13][14][15][16][17][18][19][20][21] It is important to emphasize that the relation between DI and survival in our data are not consistent with a simple biologic gradient. We produced no evidence that a gradual increase in DI beyond 3 mm is associated with a further increase in mortality.…”

“…6 Similar to our analyses, the majority of previously published studies examined the effect of DI on survival by using the cutoff levels of >3 mm or 4 mm. 11,15,16,[18][19][20]22 The biologic rationale for using this particular cutoff level needs to be understood, but the consistency of results across studies is noteworthy. We also confirmed previous reports indicating the prognostic value of tumor size 11,23,24 and the lack of an association between survival and tumor grade.…”

“…11,15,16,[18][19][20]22 The biologic rationale for using this particular cutoff level needs to be understood, but the consistency of results across studies is noteworthy. We also confirmed previous reports indicating the prognostic value of tumor size 11,23,24 and the lack of an association between survival and tumor grade. 12,[25][26][27] The literature regarding histologic features and prognosis of tongue cancer is rather voluminous and goes back at least 20 years; however, it is important to point out several differences between our report and other studies published to date.…”

“…To our knowledge, all previous studies were based on data from single institutions, whereas our analyses were population-based. Many studies examined survival in relation to DI or LVI/PNI alone, 10,[14][15][16][17]20,23,28 some examined both depth and mode of invasion, 9,[11][12][13]18,19,21,22 and relatively few conducted multivariate analyses (usually relating DI and LVI/PNI to the presence of neck metastases). 9,11,21 To our knowledge, only 1 other study evaluated the role of depth and mode of invasion simultaneously in a multivariate survival model; however, the results for DI in that study were not reported, perhaps because the authors chose to use tumor thickness as the variable of interest.…”