The prognostic role of histologic grade, worst pattern of invasion, and tumor budding in early oral tongue squamous cell carcinoma: a comparative study

• Published in: Virchows Archiv : an international journal of pathology Vol. 479; no. 3; pp. 597 - 606
• Main Authors: Xu, Bin, Salama, Abeer M., Valero, Cristina, Yuan, Avery, Khimraj, Anjanie, Saliba, Maelle, Zanoni, Daniella K., Ganly, Ian, Patel, Snehal G., Katabi, Nora, Ghossein, Ronald
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2021; Springer Nature B.V
• Subjects: Cancer; Cell Movement; Comparative studies; Disease Progression; Head & neck cancer; Head and neck carcinoma; Humans; Lymphatic Metastasis; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Metastasis; Multivariate analysis; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Oral carcinoma; Original Article; Pathology; Progression-Free Survival; Regression models; Retrospective Studies; Risk Assessment; Risk Factors; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - mortality; Squamous Cell Carcinoma of Head and Neck - secondary; Squamous Cell Carcinoma of Head and Neck - surgery; Statistical models; Survival; Time Factors; Tongue; Tongue Neoplasms - mortality; Tongue Neoplasms - pathology; Tongue Neoplasms - surgery; Tumor Burden; Tumors; Histologic grade; Tumor budding; Oral tongue squamous cell carcinoma; Prognosis; Pattern of invasion
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-021-03063-z

Major pathology guidelines often mandate stating the histologic grade as a component of the pathology report for various types of cancer. However, the prognostic value of histologic grade in head and neck squamous cell carcinoma (HNSCC) is controversial at best, and there is a need for more reliable prognostic histologic factors to better stratify and manage patients with HNSCC. In this study, we compared three relevant histopathologic features (histologic grade, worst pattern of invasion (WPOI), and tumor budding) in a large single-center retrospective cohort of early oral tongue squamous cell carcinoma (OTSCC) with tumor greatest dimension ≤ 4 cm. Only histologic grade predicted distant metastasis free survival (DMFS) on univariate analysis. Tumor budding was associated with nodal metastasis, overall survival (OS), regional recurrence-free survival (RRFS), and DMFS and was a significant predictor for nodal metastasis on the multivariable logistic regression model. WPOI 5 was associated with high frequency of nodal metastasis and shortened OS and was an independent adverse prognostic factor for OS on multivariate analysis using the Cox proportional hazards model. WPOI and tumor budding were prognostically more relevant than histologic grade. Consideration should be given to include WPOI and tumor budding in the pathology reporting of OTSCC.