Worst pattern of invasion: A prognostic indicator in early-stage oral tongue cancer: A single-center cohort study

Abstract

IntroductionThe goal of prognostic studies in early-stage oral tongue cancer is to identify the subset of patients at risk of a poor prognosis and thus need more aggressive treatment, such as multimodality therapy. This study analyses the prognostic significance of worst pattern of invasion (WPOI) in a unique population of pathologically proven node-negative early-stage oral tongue cancer patients to see if the WPOI is a prognostic marker that may help guide options of adjuvant therapy. Materials and methodsWe analyzed prospectively collected data of 192 oral squamous cell carcinoma (OSCC) patients treated between 2017 and 2021. Patients underwent curative surgery with or without adjuvant therapy. The study included only pathologically proven early-stage tongue squamous cell carcinoma (pathological T1-T2) with node-negative (N0) and complete histological details such as WPOI, Lymphocyte host response (LHR), Perinueral invasion (PNI), and Lymphovascular invasion (LVI). Statistical analysis was done using chi-square, cox multivariate analysis and Kaplan-Meier survival analysis. ResultsIn 192 patients with a mean follow-up period of 22 months, there were 39 recurrences. out of these we had 20 patients in non-aggressive WPOI and 19 in aggressive WPOI groups. TNM staging and WPOI are significantly associated with postoperative recurrence (p-value 0.029 and 0.019 respectively). However, PNI (p-value-0.954), LVI (p-value - 0.7490) and adjuvant therapy (p-value-0.733) were found to have no significant association. In our study adjuvant radiation had no role in patients with aggressive WPOI. ConclusionWPOI is an independently significant prognostic factor for postoperative recurrences. This study also found that adjuvant radiation therapy did not help in reduction of post-operative recurrences.