Worst pattern of invasion and its association with histopathological features in oral cavity cancer
PO-0844
Abstract
Worst pattern of invasion and its association with histopathological features in oral cavity cancer
Authors: Nanda|, Sambit Swarup(1)*[sambit.sambitswarup@gmail.com];Gandhi|, Ajeet K(1);Rastogi|, Madhup(1);Patni|, Ayushi(1);Khurana |, Rohini(1);Hadi|, Rahat(1);Sapru|, Shantanu(1);Rath|, Satyajeet (1);Singh|, Harikesh B(1);Kumar|, Siddararth (1);Singh|, Narayan P(1);Husain|, Nuzhat (2);
(1)Ram Manohar Lohia Institute of Medical Sciences, Radiation Oncology, Lucknow U.P, India;(2)Ram Manohar Lohia Institute of Medical Sciences, Pathology, Lucknow U.P, India;
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Purpose or Objective
Definitive treatment for oral cavity squamous cell carcinoma (OCSCC) is surgery followed by post-operative radiotherapy (PORT) with or without chemotherapy. Apart from the traditional risk factors for PORT [T3/T4, node positive, lympho-vascular space invasion (LVI) or perineural invasion (PNI), close margin, tumour thickness], recently other prognostic risk factors are also being identified like depth of invasion (DOI), tumour budding (TB) and worst pattern of invasion (WPOI). Often the high risk factors coexist together and analysis of association of these novel factors may help to predict biological behavior. We aim to report the incidence of these factors and its association with other risk factors in post-operative OCSCC patients treated at our institute.
Material and Methods
Post-operative patients of OCSCC undergoing curative oncological resection were analyzed. High risk WPOI (WPOI-5) was defined as tumour dispersion of ≥1mm between tumour satellites. For this analysis we used high risk WPOI as (WPOI 4/5). TB is defined as the presence of single cancer cell or cluster of <5 cancer cells at the invasive front. DOI and staging were used as per AJCC 8th edition. Chi square test was used for correlation between prognostic factors and a 2 sided p value of < 0.05 was considered statistically significant.
Results
Total 70 patients were analyzed. Male: Female ratio was 62:8. Primary site was oral tongue, buccal mucosa and others in 20 (28.5%), 39 (55.7%) and 11 (15.7%) patients respectively. Differentiation was well, moderate and poor in 28, 36 and 6 patients. Among these 70 patients LVI, PNI, close margin, extra-nodal extension (ENE) was respectively seen in 30 (42.8%), 15 (21.4%), 17 (24.2%) and 14 (20%) patients. As per AJCC 8th, T1:T2:T3:T4 was 6:30:24:10 and 30/70 were pN0 patients. Overall stage grouping II: III: IV was observed in 28 (40%):15 (21.4%): 27 (38.5%) patients respectively. Percentage positivity of TB, high risk WPOI and DOI ≥10 mm was 50%, 67% and 47% respectively. Association of TB, WPOI and DOI with other risk factors which were significant is enlisted in Table 1.
Conclusion
TB is associated with high risk WPOI and infiltrative pattern of invasion. High risk WPOI has association with PNI and infiltrative pattern of invasion and DOI > 10 mm is associated with higher nodal stage. Prospective reporting and documentation of these factors would help in future clinical correlation with failure patterns and help in elucidating the role of these entities as prognostic factor.