Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital.
School of Medicine.
Am J Surg Pathol. 2024 Jan 1;48(1):59-69. doi: 10.1097/PAS.0000000000002136. Epub 2023 Oct 2.
Oral squamous cell carcinoma (OSCC) is treated based on the TNM staging. However, early T-stage OSCC still exhibits substantial nodal metastasis and death rates. Recent literature highlights the independent prognostic value of worst pattern of invasion (WPOI) and tumor budding in OSCC. Nevertheless, WPOI-5 is uncommon in early T-stage OSCC, and the definitions of tumor budding and WPOI-4 overlap. Moreover, WPOI assessment is subjective, and tumor budding evaluation varies across studies. To address these limitations, we aimed to develop a modified WPOI system and a novel tumor budding scoring system that assesses single cells and high-density tumor budding. We also evaluated a new histopathologic risk model for early T-stage OSCC. The study cohort comprised 37 pT1 and 64 pT2 OSCCs. The modified WPOI demonstrated superior interobserver agreement compared with the original system (κ value: 0.98 vs. 0.53). In the multivariate analysis, modified WPOI and tumor budding score were independent prognostic factors for nodal metastasis and disease-free survival, while modified WPOI predicted disease-specific survival. By integrating these factors, our risk model stratified the patients into 3 groups. Notably, the intermediate-risk and high-risk groups exhibited significantly higher rates of nodal metastasis, recurrence, and tumor-related death. Conversely, none in the low-risk group had nodal metastasis or succumbed to the disease. Our model offered simplified scoring and potentially improved prognostic predictions. In conclusion, we've developed a modified WPOI system, a new tumor budding scoring system, and a reliable risk model that classifies early T-stage OSCC patients into distinct risk groups with significant prognostic differences.
口腔鳞状细胞癌 (OSCC) 的治疗基于 TNM 分期。然而，早期 T 期 OSCC 仍存在大量的淋巴结转移和死亡率。最近的文献强调了最差浸润模式 (WPOI) 和肿瘤芽在 OSCC 中的独立预后价值。然而，早期 T 期 OSCC 中 WPOI-5 并不常见，且肿瘤芽和 WPOI-4 的定义存在重叠。此外，WPOI 评估具有主观性，且肿瘤芽评估在不同研究中存在差异。为了解决这些局限性，我们旨在开发一种改良的 WPOI 系统和一种新的肿瘤芽评分系统，该系统可评估单个细胞和高密度肿瘤芽。我们还评估了一种新的早期 T 期 OSCC 组织病理学风险模型。该研究队列包括 37 例 pT1 和 64 例 pT2 OSCC。改良的 WPOI 与原始系统相比具有更高的观察者间一致性 (κ 值：0.98 比 0.53)。在多变量分析中，改良的 WPOI 和肿瘤芽评分是淋巴结转移和无病生存的独立预后因素，而改良的 WPOI 预测了疾病特异性生存。通过整合这些因素，我们的风险模型将患者分为 3 组。值得注意的是，中危组和高危组的淋巴结转移、复发和肿瘤相关死亡的发生率显著更高。相反，低危组无一例发生淋巴结转移或死于该疾病。我们的模型提供了简化的评分并可能改善了预后预测。总之，我们开发了一种改良的 WPOI 系统、一种新的肿瘤芽评分系统和一种可靠的风险模型，该模型可将早期 T 期 OSCC 患者分为具有显著预后差异的不同风险组。
