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Worst Pattern of Invasion as an Independent Predictor of Lymph node Metastasis and Prognosis in oral Cavity Squamous cell carcinoma – A Retrospective Cohort Study

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Abstract

Although Worst pattern of invasion (WPOI) is one of the histopathological (HP) markers that has been utilized in risk stratification of oral squamous cell carcinoma (OSCC) patients, its potential as an independent predictive factor for lymph node metastasis (LNM) and prognosis is least analyzed. Aim of the study is to analyze the relationship of various HP parameters to WPOI, their propensity for lymph node metastasis and prognostic value. This retrospective study included 140 patients diagnosed with resectable OSCC who underwent definitive surgery. Multiparametric HP risk assessment was done on the postoperative specimen and patients were categorized as low-risk WPOI (Type 1–3), and high-risk group (type 4 and 5). After categorization, 36.1% patients had low-risk WPOI and 63.9% had high-risk WPOI. Significant association was noted between WPOI and patient’s age (p = 0.001), nodal stage (p = 0.001), lymphovascular invasion (LVI) (p = 0.006) and neural invasion (p = 0.001). 87% patients with nodal metastasis had high risk WPOI. LVI (p = 0.014) and WPOI (p < 0.001) had significant predictive role in LNM. High-risk WPOI and bone involvement were found to be predictive factors for overall survival, and only high risk WPOI had strong correlation with disease free survival having significant poor prognosis. Analyzing WPOI is essential in reporting HP specimens in OSCC. High-risk WPOI can act as an independent predictor for LNM, early recurrence and poor prognosis. Incorporation of WPOI into TNM staging is recommended to improve clinician’s ability to prognosticate and individualize treatment strategies.

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Authors and Affiliations

  1. Christian Medical College, Vellore, India

    Ronald Anto, Shruthi Patil & Subhan Bhandari

  2. Department of head and neck surgery, Christian Medical College, Vellore, India

    Konduru Vidya, Amit Jiwan Tirkey, Mansi Agarwal & Jeyashanth Riju

  3. Department of Pathology, Christian Medical College, Vellore, India

    Meera Thomas

  4. Department of Biostatistics, Christian Medical College, Vellore, India

    Rekha

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Contributions

Ronald Anto: Research And Study Design, Data Collection & Analysis, Interpretation And Conclusion, Preparation Of Manuscrip, Review of Manuscript, Critical Revision

Ronald Anto: Research And Study Design, Data Collection & Analysis, Interpretation And Conclusion, Preparation Of Manuscrip, Review of Manuscript, Critical Revision

Meera Thomas: Data Collection & Analysis, Interpretation And Conclusion, Review of Manuscript

Amit Jiwan Tirkey: Research And Study Design, Interpretation And Conclusion, Preparation Of Manuscrip, Review of Manuscript, Critical Revision

Jeyasanth Riju: Data Collection & Analysis, Preparation Of Manuscrip

Shruthi Patil: Data Collection & Analysis, Preparation Of Manuscrip

Subhan Bhandari: Data Collection & Analysis

Reka: Data Collection & Analysis, Interpretation And Conclusion, Review of Manuscript

Corresponding authors

Correspondence to Ronald Anto, Meera Thomas, Amit Jiwan Tirkey, Mansi Agarwal, Jeyashanth Riju, Shruthi Patil, Subhan Bhandari or Rekha.

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The study is approved by Institutional Review Board of Christian Medical College,Vellore (IRB No: 13,431).

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Anto, R., Vidya, K., Thomas, M. et al. Worst Pattern of Invasion as an Independent Predictor of Lymph node Metastasis and Prognosis in oral Cavity Squamous cell carcinoma – A Retrospective Cohort Study. Indian J Otolaryngol Head Neck Surg 75, 440–449 (2023). https://doi.org/10.1007/s12070-022-03193-z

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