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For early-stage oral tongue cancer, depth of invasion and worst pattern of invasion are the strongest pathological predictors for locoregional recurrence and mortality

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Abstract

Despite early diagnosis and treatment, almost 20 % of patients with early-stage (cT1-cT2N0) oral tongue squamous cell carcinoma (OTSCC) still die of their disease. The prognosis of OTSCC patients is influenced by several demographic, clinical, and histopathologic factors. The aim of this multicenter international study was to find which of the factors age, gender, stage, grade, lymphocytic host response, perineural invasion, worst pattern of invasion, or depth of invasion has the strongest prognostic power in early-stage OTSCC. Patient data of 479 patients with early-stage (cT1-2N0) OTSCC in Finland, Brazil, and the USA were retrieved and analyzed using Cox proportional hazards regression models. Our results indicate that depth of invasion (DOI) and worst pattern of invasion (WPOI) are the strongest pathological predictors for locoregional recurrence, with a hazard ratio (HR) for 4 mm DOI of 1.67 (95 % confidence interval (CI) 1.07–2.60) and HR for WPOI of 1.46 (95 % CI 0.95–2.25). In addition, mortality from early OTSCC was also predicted by DOI (HR 2.44, 95 % CI 1.34–4.47) and by WPOI (HR 2.34, 95 % CI 1.26–4.32). We suggest that clinically early-stage oral tongue carcinomas 4 mm or deeper, or with a growth pattern of small cell islands or satellites, should be considered as high-risk tumors which require multimodality treatment.

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Acknowledgments

The authors express kind appreciation to Dr. Simion I. Chiosea and Dr. Ann Margaret Chang, from Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA, for sharing their data in this report. This study has been funded by the Sigrid Juselius Foundation, the Finnish Cancer Society, Finska Läkaresällskapet, and the Maritza and Reino Salonen Foundation.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland

    Alhadi Almangush, Ibrahim O. Bello, Jaana Hagström & Ilmo Leivo

  2. Institute of Dentistry, University of Misurata, Misurata, Libya

    Alhadi Almangush

  3. Department of Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, Saudi Arabia

    Ibrahim O. Bello

  4. Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, São Paulo, Brazil

    Ricardo D. Coletta

  5. Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Antti A. Mäkitie & Laura K. Mäkinen

  6. Department of Surgery, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland

    Joonas H. Kauppila

  7. Department of Pathology, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland

    Joonas H. Kauppila

  8. Department of Otorhinolaryngology and Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland

    Matti Pukkila

  9. Department of Otorhinolaryngology and Head and Neck Surgery, Tampere University Hospital, Tampere, Finland

    Jussi Laranne

  10. Department of Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland

    Ylermi Soini & Veli-Matti Kosma

  11. Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Central Hospital, Oulu, Finland

    Petri Koivunen

  12. Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil

    Natalie Kelner & Luiz Paulo Kowalski

  13. Department of Otorhinolaryngology—Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland

    Reidar Grénman

  14. Department of Pathology, University of Turku, Turku, Finland

    Ilmo Leivo

  15. Department of Mathematical Sciences and Statistics, University of Oulu, Oulu, Finland

    Esa Läärä

  16. Research Group of Cancer Research and Translational Medicine, Medical Faculty, University of Oulu, Oulu, Finland

    Tuula Salo

  17. Medical Research Center, Oulu University Hospital, Oulu, Finland

    Tuula Salo

  18. Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland

    Jaana Hagström & Tuula Salo

  19. Helsinki University Hospital, Helsinki, Finland

    Jaana Hagström & Tuula Salo

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  1. Alhadi Almangush
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  2. Ibrahim O. Bello
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  3. Ricardo D. Coletta
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  13. Natalie Kelner
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  16. Ilmo Leivo
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  17. Esa Läärä
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  18. Tuula Salo
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Correspondence to Tuula Salo.

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Almangush, A., Bello, I.O., Coletta, R.D. et al. For early-stage oral tongue cancer, depth of invasion and worst pattern of invasion are the strongest pathological predictors for locoregional recurrence and mortality. Virchows Arch 467, 39–46 (2015). https://doi.org/10.1007/s00428-015-1758-z

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  • DOI: https://doi.org/10.1007/s00428-015-1758-z

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