Worst pattern of invasion in oral squamous cell carcinoma is an independent prognostic factor

Aseem Mishra, Abhishek Das, Ipsita Dhal, Ravi Shankar, B M Bhavya, Neha Singh, Parul Tripathi, Dipti Daga, Atul Rai, Monika Gupta, Guru Charan Sahu, Aseem Mishra, Abhishek Das, Ipsita Dhal, Ravi Shankar, B M Bhavya, Neha Singh, Parul Tripathi, Dipti Daga, Atul Rai, Monika Gupta, Guru Charan Sahu

Abstract

Introduction: Biologic aggressiveness of OSCC (Oral Cavity Squamous Cell Carcinoma), has intrigued research in various prognosticating histopathological markers over past few decades. DOI (Depth of Invasion) is one such histopathological factor which affects outcomes and was included in the AJCC 8th edition TNM staging. Pattern of Invasion (POI) has been widely reported as an adverse prognostic factor associated with higher locoregional failure and poor prognosis. However, these factors are not utilized for treatment decision making and for outcome assessment.

Materials and methods: This is a retrospective analysis of 320 patients with OSCC who underwent treatment, from October 2018-February 2020. Clinic demographic details were extracted from electronic medical records. Univariate and multivariate analysis was done for the parameters. WPOI (Worst Pattern of Invasion) was correlated with all histopathological prognostic factors. Survival analysis was done using Kaplan Meier for WPOI type's I-V. DFS (Disease free Survival) was evaluated for different grades of WPOI.

Results: We analyzed the results comparing, early and advanced T (Tumor) stages, cohesive WPOI I-III, non-cohesive WPOI IV-V. Univariate analysis showed a significant association of T-stage (p = 0.001), N (Nodal) -stage (p = 0.002), DOI (p = 0.008), PNI (Peri-neural invasion) (0.001) and Tumor differentiation Grade (p = 0.001). On multivariate analysis, non-cohesive WPOI (IV & V) showed significant association with grade, PNI, DOI (0.002, 0.033 & 0.033 respectively). Non-cohesive WPOI had significantly higher locoregional failures and short DFS.

Conclusion: Presence of invasive WPOI is associated with advanced T stage, poor differentiation, PNI, greater depth of invasion, and higher chances of nodal metastasis. WPOI is associated with poor DFS, treatment intensification in early stage disease with WPOI type IV & V may improve survival.

Keywords: Aggressive Tumor Biology; DFS, Disease Free Survival; DOI, Depth of Invasion; Histopathological features; LVE, Lymphovascular emboli; N- Stage, N stage; OSCC, Oral Cavity Squamous Cell Carcinoma; Oral Squamous Cell Carcinoma; PNI, Peri neural invasion; POI, Pattern of Invasion; T-stage, Tumor Stage; WPOI, Worst Pattern of Invaion; Worst Pattern of Invasion.

Conflict of interest statement

None.

© 2022 Craniofacial Research Foundation. Published by Elsevier B.V.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
A. Pattern Of Invasion Type 1: Tumor invasion is in broad pushing manner (40x), B. POI Type 2 represents tumor invading in solid cords and strands (“finger-like")(100x), C. POI Type 3 shows invasive islands of the tumor with >15 cells cluster (100x), D. POI Type 4 represents invasive tumor islands with

Graph 1

WPOI association with DOI, PNI…

Graph 1

WPOI association with DOI, PNI and Tumor differentiation.

Graph 1
WPOI association with DOI, PNI and Tumor differentiation.

Graph 2

Kaplan Meier graph showing Disease…

Graph 2

Kaplan Meier graph showing Disease free survival.

Graph 2
Kaplan Meier graph showing Disease free survival.
Graph 1
Graph 1
WPOI association with DOI, PNI and Tumor differentiation.
Graph 2
Graph 2
Kaplan Meier graph showing Disease free survival.

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