Reframing Histological Risk Assessment of Oral Squamous Cell Carcinoma in the Era of UICC 8th Edition TNM Staging
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ORIGINAL PAPER
Reframing Histological Risk Assessment of Oral Squamous Cell Carcinoma in the Era of UICC 8th Edition TNM Staging Naomi Rahman1,2 · Morna MacNeill3 · William Wallace3 · Brendan Conn3 Received: 3 May 2020 / Accepted: 9 June 2020 © The Author(s) 2020
Abstract Objectives To assess whether application of the risk model originally proposed by Brandwein-Gensler, influences survival and disease progression in patients treated for oral squamous cell carcinoma (OSCCs) Materials and Methods Tumours from 134 T1 and T2 OSCC resections (7th edition) were scored independently by 3 histopathologists according to worst pattern of invasion (WPOI), lymphocytic host response (LHR) and perineural invasion (PNI) and categorised according to risk score. Local recurrence, locoregional recurrence, disease progression and overall survival were study endpoints. Interobserver variability of pathologist scoring was also assessed. Results Seventy-two patients (54%) were classified with low or intermediate risk and 62 (46%) patients were ‘high risk’. The inter-observer agreement was in moderate to strong agreement with the consensus scores (k range = 0.45–0.82). There was statistical significance between distant metastasis and ‘high risk’ tumours. Thirty tumours were upstaged to T3 in the 8th edition TNM staging, of which 83% had high risk scores. Overall risk score and TNM8 T stage has significant correlation with overall survival in comparison to the TNM 7 T stage. Conclusion ‘High risk’ tumours were significantly associated with distant metastasis possibly due to the greater likelihood of aggressive features such as WPOI and PNI. Primary tumours are more likely to express high risk features with increasing T stage. None of the patients classified as ‘low risk’ died perhaps suggesting these tumours represent a rare variant of OSCC with excellent prognosis. Keywords Oral squamous cell carcinoma Pattern of invasion · Lymphocytic host response · Perineural invasion Abbreviations OSCC Oral squamous cell carcinoma POI Pattern of invasion WPOI Worst pattern of invasion TIL Tumour infiltrate lymphocyte LHR Lymphocytic host response PNI Perineural invasion
* Brendan Conn [email protected] Naomi Rahman [email protected] 1
Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, Scotland
2
Present Address: East Surrey Hospital, Canada Avenue, Redhill RH1 5RH, UK
3
Royal Infirmary of Edinburgh, 51 Little France Crescent , Old Dalkeith Road, Edinburgh EH16 4SA, Scotland
Introduction Oral squamous cell carcinoma (OSCC) is the most common malignancy of the head and neck [1] with estimated global deaths from oral cancer of 177,000 in 2018 [2]. Despite advances in diagnostic techniques and treatment modalities, the overall survival of patients with head and neck cancer has not improved significantly over the past 20 years [3]. The evaluation of the clinical characteristics and anatomical extent of the tumour as well as its relationship to host tissues plays an important role in
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