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Prognostic value of clinicopathological parameters and outcome in 484 patients with oral squamous cell carcinoma: microvascular invasion (V+) is an independent prognostic factor for OSCC

Abstract

Background

Several clinicopathological parameters have been implicated in prognosis, recurrence and survival, following oral squamous cell carcinoma (OSCC). The purpose of this retrospective study was to review the outcome of patients with oral cavity squamous cell carcinoma treated at a single institution by primary surgical resection with or without adjuvant radiotherapy or radiochemotherapy, or brachytherapy and to identify the factors affecting survival and locoregional control.

Materials and methods

We retrospectively reviewed the records of 429 consecutive patients after primary radical R0 tumor resection and 55 patients after brachytherapy in our department between 1997 and 2010. OSCC pathological parameters were analyzed including age, gender, site distribution, tumor size, lymph node involvement, grading, microvascular invasion, lymphatic vessel involvement, and distant metastasis. Descriptive statistics were calculated for each variable and survival was calculated using the univariate Kaplan–Meier method. Prognostic factors were analyzed using the multivariate Cox proportional hazard model.

Results

Average tumor size was 10.9 mm (95 % CI for the mean 9.6–12.3). Disease-free survival at 5 years was 65 % and overall 5-year survival was 62 %. On univariate analysis, patients with increased tumor size, lymph node involvement, microvascular invasion, and lymphatic vessel involvement had a significant poor prognosis. Multivariate analysis showed that independent prognostic factors were increased tumor size and microvascular invasion.

Conclusion

This hospital-based retrospective cohort study points out different clinicopathological prognostic factors of survival in a large patient cohort treated for OSCC. It highlights increased tumor size and microvascular invasion as the most independent prognostic factors in predicting survival in patients with OSCC.

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References

  1. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. doi:10.1056/NEJMoa032641350/19/1945

    PubMed  Article  CAS  Google Scholar 

  2. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. doi:10.1056/NEJMoa032646350/19/1937]

    PubMed  Article  Google Scholar 

  3. Mazeron JJ, Crook JM, Benck V, Marinello G, Martin M, Raynal M, Haddad E, Peynegre R, Le Bourgeois JP, Walop W et al (1990) Iridium 192 implantation of T1 and T2 carcinomas of the mobile tongue. Int J Radiat Oncol Biol Phys 19(6):1369–1376

    PubMed  Article  CAS  Google Scholar 

  4. Lapeyre M, Hoffstetter S, Peiffert D, Guerif S, Maire F, Dolivet G, Toussaint B, Mundt A, Chassagne JF, Simon C, Bey P (2000) Postoperative brachytherapy alone for T1–2 N0 squamous cell carcinomas of the oral tongue and floor of mouth with close or positive margins. Int J Radiat Oncol Biol Phys 48(1):37–42. doi:S0360-3016(00)00538-1

    PubMed  Article  CAS  Google Scholar 

  5. Grandi C, Alloisio M, Moglia D, Podrecca S, Sala L, Salvatori P, Molinari R (1985) Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. Head Neck Surg 8(2):67–73

    PubMed  Article  CAS  Google Scholar 

  6. Greenberg JS, Fowler R, Gomez J, Mo V, Roberts D, El Naggar AK, Myers JN (2003) Extent of extracapsular spread: a critical prognosticator in oral tongue cancer. Cancer 97(6):1464–1470. doi:10.1002/cncr.11202

    PubMed  Article  Google Scholar 

  7. Sano D, Myers JN (2007) Metastasis of squamous cell carcinoma of the oral tongue. Cancer Metastasis Rev 26(3–4):645–662. doi:10.1007/s10555-007-9082-y

    PubMed  Article  CAS  Google Scholar 

  8. Liao CT, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Chen IH, Huang SF, Cheng AJ, Yen TC (2007) Survival in squamous cell carcinoma of the oral cavity: differences between pT4 N0 and other stage IVA categories. Cancer 110(3):564–571. doi:10.1002/cncr.22814

    PubMed  Article  Google Scholar 

  9. Yoshizawa M, Shingaki S, Nakajima T, Saku T (1994) Histopathological study of lymphatic invasion in squamous cell carcinoma (O-1 N) with high potential of lymph node metastasis. Clin Exp Metastasis 12(6):347–356

    PubMed  Article  CAS  Google Scholar 

  10. Zhao D, Pan J, Li XQ, Wang XY, Tang C, Xuan M (2008) Intratumoral lymphangiogenesis in oral squamous cell carcinoma and its clinicopathological significance. J Oral Pathol Med 37(10):616–625. doi:JOP70710.1111/j.1600-0714.2008.00707.x

    PubMed  Article  CAS  Google Scholar 

  11. Nakayama A, Ogawa A, Fukuta Y, Kudo K (1999) Relation between lymphatic vessel diameter and clinicopathologic parameters in squamous cell carcinomas of the oral region. Cancer 86(2):200–206. doi:10.1002/(SICI)1097-0142(19990715)86:2<200:AID-CNCR3>3.0.CO;2-#

    PubMed  Article  CAS  Google Scholar 

  12. Goerkem M, Braun J, Stoeckli SJ (2010) Evaluation of clinical and histomorphological parameters as potential predictors of occult metastases in sentinel lymph nodes of early squamous cell carcinoma of the oral cavity. Ann Surg Oncol 17(2):527–535. doi:10.1245/s10434-009-0755-3

    PubMed  Article  Google Scholar 

  13. Jones HB, Sykes A, Bayman N, Sloan P, Swindell R, Patel M, Musgrove B (2009) The impact of lymphovascular invasion on survival in oral carcinoma. Oral Oncol 45(1):10–15. doi:10.1016/j.oraloncology.2008.03.009

    PubMed  Article  CAS  Google Scholar 

  14. Niimi K, Yoshizawa M, Nakajima T, Saku T (2001) Vascular invasion in squamous cell carcinomas of human oral mucosa. Oral Oncol 37(4):357–364. doi:S1368-8375(00)00097-X

    PubMed  Article  CAS  Google Scholar 

  15. 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

    PubMed  Article  CAS  Google Scholar 

  16. Maddox WA, Urist MM (1990) Histopathological prognostic factors of certain primary oral cavity cancers. Oncology (Williston Park) 4 (12):39–42; discussion 42, 45–36

  17. Kurokawa H, Yamashita Y, Murata T, Yoshikawa T, Tokudome S, Miura K, Kajiyama M (1998) Histological grading of malignancy correlates with regional lymph node metastasis and survival of patients with oral squamous cell carcinoma. Fukuoka Igaku Zasshi 89(8):225–231

    PubMed  CAS  Google Scholar 

  18. Larsen SR, Johansen J, Sorensen JA, Krogdahl A (2009) The prognostic significance of histological features in oral squamous cell carcinoma. J Oral Pathol Med 38(8):657–662. doi:10.1111/j.1600-0714.2009.00797.x

    PubMed  Article  CAS  Google Scholar 

  19. Brandwein-Gensler M, Teixeira MS, Lewis CM, Lee B, Rolnitzky L, Hille JJ, Genden E, Urken ML, Wang BY (2005) Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol 29(2):167–178. doi:00000478-200502000-00003

    PubMed  Article  Google Scholar 

  20. Kurita H, Koike T, Narikawa JN, Sakai H, Nakatsuka A, Uehara S, Kobayashi H, Kurashina K (2004) Clinical predictors for contralateral neck lymph node metastasis from unilateral squamous cell carcinoma in the oral cavity. Oral Oncol 40(9):898–903. doi:10.1016/j.oraloncology.2004.04.004

    PubMed  Article  Google Scholar 

  21. Sobin LH, Wittekind Ch (2002) UICC. TNM Classification of malignant tumors, 6th edn. Springer, Berlin

  22. Hamilton SR, Aaltonen LA (2000) Pathology and genetics. Tumours of the digestive system, 3rd edn. IARC Press, Lyon

  23. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 75:457–487

    Article  Google Scholar 

  24. Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50(3):163–170

    PubMed  CAS  Google Scholar 

  25. Cox DR (1972) Regression models and life tables. J Roy Stat Soc 34:1987–2001

    Google Scholar 

  26. Mucke T, Wagenpfeil S, Kesting MR, Holzle F, Wolff KD (2009) Recurrence interval affects survival after local relapse of oral cancer. Oral Oncol 45(8):687–691. doi:10.1016/j.oraloncology.2008.10.011

    PubMed  Article  Google Scholar 

  27. Liu SA, Wong YK, Lin JC, Poon CK, Tung KC, Tsai WC (2007) Impact of recurrence interval on survival of oral cavity squamous cell carcinoma patients after local relapse. Otolaryngol Head Neck Surg 136(1):112–118. doi:10.1016/j.otohns.2006.07.002

    PubMed  Article  Google Scholar 

  28. Bagan JV, Scully C (2008) Recent advances in oral oncology 2007: epidemiology, aetiopathogenesis, diagnosis and prognostication. Oral Oncol 44(2):103–108. doi:S1368-8375(08)00009-2

    PubMed  Article  Google Scholar 

  29. Jones AS, Beasley N, Houghton D, Husband DJ (1998) The effects of age on survival and other parameters in squamous cell carcinoma of the oral cavity, pharynx and larynx. Clin Otolaryngol Allied Sci 23(1):51–56

    PubMed  Article  CAS  Google Scholar 

  30. Carinci F, Pelucchi S, Farina A, Bonsetti G, Mastrandrea M, Calearo C (1997) Site-dependent survival in cancer of the oral cavity. J Craniofac Surg 8(5):399–403 (discussion 404)

    PubMed  Article  CAS  Google Scholar 

  31. Jerjes W, Upile T, Petrie A, Riskalla A, Hamdoon Z, Vourvachis M, Karavidas K, Jay A, Sandison A, Thomas GJ, Kalavrezos N, Hopper C (2010) Clinicopathological parameters, recurrence, locoregional and distant metastasis in 115 T1–T2 oral squamous cell carcinoma patients. Head Neck Oncol 2:9. doi:1758-3284-2-910.1186/1758-3284-2-9

    PubMed  Article  Google Scholar 

  32. Favia G, Maiorano E, Capodiferro S, Pilolli GP, Lacaita MG, Lajolo C, Giuliani M, Martinelli D, Germinario C (2008) Oral squamous cell carcinoma: a mono-institutional epidemiological study on 462 cases highlighting differences among young and adult patients. Minerva Stomatol 57(9):413–421

    PubMed  CAS  Google Scholar 

  33. Skitarelic N, Morovic M, Manestar D (2007) Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery. J Craniomaxillofac Surg 35(1):15–20. doi:S1010-5182(07)00005-4

    PubMed  Article  Google Scholar 

  34. Gil Z, Carlson DL, Boyle JO, Kraus DH, Shah JP, Shaha AR, Singh B, Wong RJ, Patel SG (2009) Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer 115(24):5700–5710. doi:10.1002/cncr.24631

    PubMed  Article  Google Scholar 

  35. Barnes L, Everson J, Reichart P, Sidransky D (2005) World Health Organization classification of tumours: pathology and genetics of head and neck tumors. IARC Press, Lyon, pp 168–174

  36. Neville BW, Day TA (2002) Oral cancer and precancerous lesions. CA Cancer J Clin 52(4):195–215

    PubMed  Article  Google Scholar 

  37. Papageorge MB (2007) Etiology of oral cancer in the young patient: is tongue cancer becoming the other cancer in women? Oral Maxillofac Surg Clin North Am 19 (2):163–171. doi:10.1016/j.coms.2007.01.004

  38. Effiom OA, Adeyemo WL, Omitola OG, Ajayi OF, Emmanuel MM, Gbotolorun OM (2008) Oral squamous cell carcinoma: a clinicopathologic review of 233 cases in Lagos, Nigeria. J Oral Maxillofac Surg 66(8):1595–1599. doi:10.1016/j.joms.2007.12.025

    PubMed  Article  Google Scholar 

  39. Walker D, Boey G, McDonald L (2003) The pathology of oral cancer. Pathology 35:376–383

    PubMed  Article  Google Scholar 

  40. Curado MP, Hashibe M (2009) Recent changes in the epidemiology of head and neck cancer. Curr Opin Oncol 21(3):194–200. doi:10.1097/CCO.0b013e32832a68ca

    PubMed  Article  Google Scholar 

  41. Lin CS, Jen YM, Cheng MF, Lin YS, Su WF, Hwang JM, Chang LP, Chao HL, Liu DW, Lin HY, Shum WY (2006) Squamous cell carcinoma of the buccal mucosa: an aggressive cancer requiring multimodality treatment. Head Neck 28(2):150–157. doi:10.1002/hed.20303

    PubMed  Article  Google Scholar 

  42. Wong RJ, Keel SB, Glynn RJ, Varvares MA (2000) Histological pattern of mandibular invasion by oral squamous cell carcinoma. Laryngoscope 110(1):65–72. doi:10.1097/00005537-200001000-00013

    PubMed  Article  CAS  Google Scholar 

  43. Ritchie JM, Smith EM, Summersgill KF, Hoffman HT, Wang D, Klussmann JP, Turek LP, Haugen TH (2003) Human papillomavirus infection as a prognostic factor in carcinomas of the oral cavity and oropharynx. Int J Cancer 104(3):336–344. doi:10.1002/ijc.10960

    PubMed  Article  CAS  Google Scholar 

  44. Schiefke F, Hildebrandt G, Pohlmann S, Heinicke F, Hemprich A, Frerich B (2008) Combination of surgical resection and HDR-brachytherapy in patients with recurrent or advanced head and neck carcinomas. J Craniomaxillofac Surg 36(5):285–292. doi:10.1016/j.jcms.2007.08.009

    PubMed  Article  Google Scholar 

  45. Do L, Puthawala A, Syed N (2009) Interstitial brachytherapy as boost for locally advanced T4 head and neck cancer. Brachytherapy 8(4):385–391. doi:10.1016/j.brachy.2009.03.191

    PubMed  Article  Google Scholar 

  46. Severino P, Alvares AM, Michaluart P Jr, Okamoto OK, Nunes FD, Moreira-Filho CA, Tajara EH (2008) Global gene expression profiling of oral cavity cancers suggests molecular heterogeneity within anatomic subsites. BMC Res Notes 1:113. doi:10.1186/1756-0500-1-113

    PubMed  Article  Google Scholar 

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Acknowledgments

The author thanks the assistance of Mrs. Corinna Buettner for her technical support.

Conflict of interest

The author declares that he has no competing interests.

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Correspondence to M. Grimm.

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Grimm, M. Prognostic value of clinicopathological parameters and outcome in 484 patients with oral squamous cell carcinoma: microvascular invasion (V+) is an independent prognostic factor for OSCC. Clin Transl Oncol 14, 870–880 (2012). https://doi.org/10.1007/s12094-012-0867-2

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  • DOI: https://doi.org/10.1007/s12094-012-0867-2

Keywords

  • Prognostic factors
  • Clinicopathological parameters
  • Oral squamous cell carcinoma