Abstract
Objectives
Tumor invasion into blood and/or lymphatic vessels, perineural invasion, and histopathological grading are evaluated to assess the biological aggressiveness of oral squamous cell carcinoma (OSCC). We aim to assess the prognostic impact of a novel scoring system, based upon the aforementioned histological parameters.
Materials and methods
Retrospective chart review of 334 patients with treatment-naive squamous cell carcinoma of the oral cavity. Statistical analysis was performed using univariate and multivariate analysis. Histological grade G1 or G2 were assigned 0 points and G3 or G4 1 point. Invasion of the lymphatic vessels, blood vessels, or perineural space was given 1 point. Zero points were given, when invasion was not detectable. The final score was conducted through addition of each parameter. Therefore, our scoring system ranged between 0 and 4 points.
Results
T-classification (p < 0.001), N-classification (p < 0.001), UICC stage (p < 0.001), extracapsular spread (p < 0.001), locoregional recurrence (p < 0.001), and overall survival (p < 0.001) were significantly associated with the OSCC-Histoscore. In multivariate analysis, T-classification (p = 0.001), N-classification (p = 0.039), resection margins (p = 0.038), and OSCC-Histoscore (p < 0.001) were independent prognostic markers for overall survival rate.
Conclusion
Our presented OSCC-Histoscore serves as a strong independent prognostic parameter for 5-year overall survival (OS) and predicts OS better than T-classification, N-classification, and resection margins.
Clinical relevance
Our presented histoscore improves prediction of the overall survival of patients with OSCC.
Similar content being viewed by others
References
Vormittag L, Thurnher D, Geleff S, Pammer J, Heiduschka G, Brunner M, Grasl M, Erovic BM (2009) Co-expression of Bmi-1 and podoplanin predicts overall survival in patients with squamous cell carcinoma of the head and neck treated with radio (chemo)therapy. Int J Radiat Oncol Biol Phys 73(3):913–918
Kreppel M, Dreiseidler T, Rothamel D, Eich HT, Drebber U, Zoller JE, Scheer M (2013) The role of clinical versus histopathological staging in patients with advanced oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy followed by radical surgery. J Craniomaxillofac Surg 41(1):22–27
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249
Safi AF, Kauke M, Grandoch A, Nickenig HJ, Zoller JE, Kreppel M (2017) Analysis of clinicopathological risk factors for locoregional recurrence of oral squamous cell carcinoma - retrospective analysis of 517 patients. J Craniomaxillofac Surg 45(10):1749–1753
Safi AF, Kauke M, Grandoch A, Nickenig HJ, Drebber U, Zoller J, Kreppel M (2017) Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection. J Craniomaxillofac Surg 45:2092–2096
Safi AF, Kauke M, Grandoch A, Nickenig HJ, Drebber U, Zoller J, Kreppel M (2017) The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma. Oral Oncol 72:48–55
Safi AF, Grandoch A, Nickenig HJ, Zoller JE, Kreppel M (2017) Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa. Head Neck 39:2488–2493
Safi AF, Grandoch A, Nickenig HJ, Zoller JE, Kreppel M (2017) The importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the tongue. J Craniomaxillofac Surg 45(7):1058–1061
Bloebaum M, Poort L, Bockmann R, Kessler P (2014) Survival after curative surgical treatment for primary oral squamous cell carcinoma. J Craniomaxillofac Surg 42(8):1572–1576
Feller L, Lemmer J (2012) New ‘second primary’ cancers. SADJ 67(4):175–178
Martin-Villar E, Scholl FG, Gamallo C, Yurrita MM, Munoz-Guerra M, Cruces J, Quintanilla M (2005) Characterization of human PA2.26 antigen (T1alpha-2, podoplanin), a small membrane mucin induced in oral squamous cell carcinomas. Int J Cancer 113(6):899–910
Patel V, Leethanakul C, Gutkind JS (2001) New approaches to the understanding of the molecular basis of oral cancer. Crit Rev Oral Biol Med 12(1):55–63
Greene FL, Sobin LH (2002) The TNM system: our language for cancer care. J Surg Oncol 80(3):119–120
Po Wing Yuen A, Lam KY, Lam LK, Ho CM, Wong A, Chow TL, Yuen WF, Wei WI (2002) Prognostic factors of clinically stage I and II oral tongue carcinoma-a comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck 24(6):513–520
Broders AC (1920) Squamous-cell epithelioma of the lip: a study of five hundred and thirty-seven cases. J Am Med Assoc 74(10):656–664
Maddox WA, Urist MM (1990) Histopathological prognostic factors of certain primary oral cavity cancers. Oncology (Williston Park, NY) 4(12):39–42 discussion 42, 45–6
Olsen KD, Caruso M, Foote RL, Stanley RJ, Lewis JE, Buskirk SJ, Frassica DA, DeSanto LW, O'Fallon WM, Hoverman VR (1994) Primary head and neck cancer: histopathologic predictors of recurrence after neck dissection in patients with lymph node involvement. Arch Otolaryngol Head Neck Surg 120(12):1370–1374
Woolgar JA (1999) T2 carcinoma of the tongue: the histopathologist’s perspective. Br J Oral Maxillofac Surg 37(3):187–193
Smith BD, Haffty BG (2009) Prognostic factors in patients with head and neck cancer. Head and neck cancer: a multidisciplinary approach, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 51–75
Kreppel M, Scheer M, Drebber U, Ritter L, Zoller JE (2010) Impact of podoplanin expression in oral squamous cell carcinoma: clinical and histopathologic correlations. Virchows Arch 456(5):473–482
Safi AF, Nickenig HJ, Rothamel D, Zirk M, Thiele O, Grandoch A, Scheer M, Zinser M, Zoller J, Drebber U, Kreppel M (2015) Expression of ezrin in oral squamous cell carcinoma: prognostic impact and clinicopathological correlations. J Craniomaxillofac Surg 43(9):1899–1905
Close LG, Brown PM, Vuitch MF, Reisch J, Schaefer SD (1989) Microvascular invasion and survival in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 115(11):1304–1309
Michikawa C, Uzawa N, Kayamori K, Sonoda I, Ohyama Y, Okada N, Yamaguchi A, Amagasa T (2012) Clinical significance of lymphatic and blood vessel invasion in oral tongue squamous cell carcinomas. Oral Oncol 48(4):320–324
Van den Eynden GG, Van der Auwera I, Van Laere SJ, Colpaert CG, van Dam P, Dirix LY, Vermeulen PB, Van Marck EA (2006) Distinguishing blood and lymph vessel invasion in breast cancer: a prospective immunohistochemical study. Br J Cancer 94(11):1643–1649
Doshi NP, Shah SA, Patel KB, Jhabuawala MF (2011) Histological grading of oral cancer: a comparison of different systems and their relation to lymph node metastasis. National Journal of Community Medicine 2(1):136–142
Brandwein-Gensler M, Smith RV, Wang B, Penner C, Theilken A, Broughel D, Schiff B, Owen RP, Smith J, Sarta C, Hebert T, Nason R, Ramer M, DeLacure M, Hirsch D, Myssiorek D, Heller K, Prystowsky M, Schlecht NF, Negassa A (2010) Validation of the histologic risk model in a new cohort of patients with head and neck squamous cell carcinoma. Am J Surg Pathol 34(5):676–688
Frierson HF Jr, Cooper PH (1986) Prognostic factors in squamous cell carcinoma of the lower lip. Hum Pathol 17(4):346–354
Hibbert J, Marks NJ, Winter PJ, Shaheen OH (1983) Prognostic factors in oral squamous carcinoma and their relation to clinical staging. Clin Otolaryngol Allied Sci 8(3):197–203
Giacomarra V, Tirelli G, Papanikolla L, Bussani R (1999) Predictive factors of nodal metastases in oral cavity and oropharynx carcinomas. Laryngoscope 109(5):795–799
Jakobsson P, Eneroth CM, Killander D, Moberger G, Mårtensson B (1973) Histologic classification and grading of malignancy in carcinoma of the larynx. Acta radiologica: therapy, physics, biology 12(1):1–8
Bryne M, Boysen M, Alfsen CG, Abeler VM, Sudbø J, Nesland JM, Kristensen GB, Piffko J, Bankfalvi A (1997) The invasive front of carcinomas. The most important area for tumour prognosis? Anticancer Res 18(6B):4757–4764
Lund C, Sosgaard H, Elbrønd O, Jørgensen K, Andersen AP (1975) Epidermoid carcinoma of the lip histologic grading in the clinical evaluation. Acta radiologica: therapy, physics, biology 14(5):465–474
Willen R, Nathanson A, Moberger G, Anneroth G (1975) Squamous cell carcinoma of the gingiva: histological classification and grading of malignancy. Acta Otolaryngol 79(1–2):146–154
Anneroth G, Batsakis J, Luna M (1987) Review of the literature and a recommended system of malignancy grading in oral squamous cell carcinomas. Scand J Dent Res 95(3):229–249
Crissman JD, Gluckman J, Whiteley J, Quenelle D (1980) Squamous-cell carcinoma of the floor of the mouth. Head Neck Surg 3(1):2–7
Vila CN, Martínez-Gimeno C, Rodríguez EM, Varela CL (1995) Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metastasis. Laryngoscope 105(7):728–733
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
Due to the retrospective nature of this study, it was granted an exemption in writing by the University Hospital of Cologne IRB. Our investigation followed the guidelines of the Helsinki Declaration. This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
For this type of study, formal consent is not required.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Safi, AF., Grochau, K., Drebber, U. et al. A novel histopathological scoring system for patients with oral squamous cell carcinoma. Clin Oral Invest 23, 3759–3765 (2019). https://doi.org/10.1007/s00784-019-02804-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-019-02804-4