Tumor budding score predicts lymph node status in oral tongue squamous cell carcinoma and should be included in the pathology report

Abstract

Background The majority of oral cavity cancers arise in the oral tongue. The aim of this study was to evaluate the prognostic value of tumor budding in oral tongue squamous cell carcinoma, both as a separate variable and in combination with depth of invasion. We also assessed the prognostic impact of the 8th edition of the American Joint Committee on Cancer's TNM classification (TNM8), where depth of invasion (DOI) supplements diameter in the tumor size (T) categorization. Methods Patients diagnosed with primary oral tongue squamous cell carcinoma were evaluated retrospectively. Spearman bivariate correlation analyses with bootstrapping were used to identify correlation between variables. Prognostic value of clinical and histopathological variables was assessed by Log rank and Cox regression analyses with bootstrapping using 5-year disease specific survival as outcome. The significance level for the hypothesis test was 0.05. Results One-hundred and fifty patients had available material for microscopic evaluation on Hematoxylin and Eosin-stained slides and were included in the analyses. Reclassification of

Emerging histopathologic markers in early‐stage oral tongue cancer: A systematic review and meta‐analysis

“…Regarding the emerging prognostic markers that are not included in the pathology report, the published studies revealed a promising prognostic value for cancer‐related histopathologic markers including cell‐in‐cell structures (one study), 19 tumor budding (seven studies), 13,15,25–29 and pattern of invasion (15 studies) which were evaluated either as mode of invasion, 22,30 pattern of invasion, 31–34 invasive pattern, 28 or WPOI 13,16,25,35–39 . At the same time, some of the relevant studies analyzed stromal‐related histopathologic markers including stromal infiltrating lymphocytes (one study) 18 and tumor–stroma ratio (TSR; three studies) 17,40,41 which were significantly associated with prognosis.…”

“…The meta‐analysis of OS revealed some heterogeneity ( I 2 = 44%). For DSS, two studies 15,25 were included in the meta‐analysis and are visualized using a forest plot (Figure 2B). Again, tumor budding was indicated to be a predictor of DSS (HR 1.89, 95% CI 1.13–3.15; p = 0.02).…”

“…Although these have shown good prognostic value for early‐stage OTSCC, they are not included in clinical implementation. Examples of such markers include tumor budding, 13–15 worst pattern of invasion (WPOI), 13,16 tumor stroma ratio (TSR), 17 tumor‐infiltrating lymphocytes (TILs), 18 and cell‐in‐cell phenomenon, 19 which has been recently studied in many cancers including early OTSCC 19 …”

The Impact of Post-Operative Radiotherapy in Early Stage (pT1-pT2N0M0) Oral Tongue Squamous Cell Carcinoma in Era of DOI

“…The major pitfalls of our study are its retrospective nature, lack of centralized pathology revision, and the lack of a pathological nodal staging for half of the patients. Moreover, other prognosticators such as the pattern of invasion, PNI density foci, and tumor budding, which were recently demonstrated to be expression of tumor biological behavior, were not available [ 18 , 19 , 20 ].…”

Evaluation of Depth of Invasion and Tumor Thickness as a Prognostic Factor for Early-Stage Oral Squamous Cell Carcinoma: A Retrospective Study

“…Piazza et al (2019) and Bjerkli et al (2020) suggested that the 8th edition of the AJCC staging system improved the prognostic value of the T category than the previous one in early-stage oral tongue SCC [ 19 , 20 ]. Contrary to Piazza et al (2019) and Bjerkli et al (2020), our results are more relevant to Kano et al (2018) As this study included a relatively small number of patients and all oral cavity subsites, additional studies using a larger patient population are needed.…”