Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Pathol Res Pract. 2024 Jan;253:155052. doi: 10.1016/j.prp.2023.155052. Epub 2023 Dec 21.
Head and neck squamous cell carcinoma (HNSCC) is an aggressive cancer with an increased frequency of lymph node metastasis at the time of presentation. Tumour budding, characterised by the presence of a single cell or a small grouping of tumour cells (a cluster containing fewer than five malignant cells) at the invasive front and composition of the fibrotic cancer stroma has been demonstrated to have a growing impact on the behaviour of the solid tumour. However exact role played by them is yet to be defined and a standardized scoring system needs to be incorporated.
A total of 45 histopathologically confirmed cases of HNSCC were included in the study. Hematoxylin and Eosin staining (H&E staining), and immunohistochemistry for CK and alpha-SMA were applied to study the tumour budding and fibrotic cancer stroma in all HNSCC cases. The tumour budding was graded as, Grade 1: 0-4 tumour buds, Grade 2: 5-9 buds and Grade 3: ≥ 10 buds and the nature of fibrotic cancer stroma was categorized as mature, intermediate or immature.
Among 45 cases analyzed, well differentiated squamous cell carcinoma (WDSCC; Grade 1) accounted for 42.22% (19 cases), whereas moderately differentiated squamous cell carcinoma (MDSCC; Grade 2) and poorly differentiated squamous cell carcinoma (PDSCC; Grade 3) comprised 48.89% (22 cases) and 8.89% (4 cases) respectively. Tumour budding showed instances of 0-4 buds in 33.3% (Grade 1), 5-9 buds in 48.9% (Grade 2), and ≥ 10 buds in 17.8% of cases. Evaluating tumour stroma, Intermediate stroma led at 51.1%, Mature at 37.8%, and 11.1% displayed Immature stroma. Histologically, < 5 buds were seen in 47.4% of Grade 1 cases, while ≥ 10 buds were in 75.0% of Grade 3 cases, proven statistically significant (p = 0.021). However, an association between T&N Stage and tumour budding lacked significance. WDSCC notably had more mature stroma than MDSCC and PDSCC, whereas MDSCC showed higher rates of intermediate and immature stroma (p < 0.001). Comparatively, no significant correlation existed between fibrotic stroma and tumour budding (p = 0.076). Also, fibrotic stroma was compared with tumour budding, however, no significant correlation was found (p = 0.076) CONCLUSION: This study reveals a significant link between tumour budding, cancer stroma, and WHO tumour grade. Thus, evaluating these factors in HNSCC cases can serve as valuable histological prognostic indicators, aiding in treatment planning and prognosis assessment.
头颈部鳞状细胞癌（HNSCC）是一种侵袭性癌症，在发病时淋巴结转移的频率增加。肿瘤芽殖是指在侵袭前沿存在单个细胞或少量肿瘤细胞（簇中含有少于 5 个恶性细胞），以及纤维化癌基质的组成，这已被证明对实体瘤的行为有越来越大的影响。然而，它们的确切作用尚未确定，需要纳入标准化评分系统。
本研究共纳入 45 例经组织病理学证实的 HNSCC 病例。对所有 HNSCC 病例进行苏木精和伊红染色（H&E 染色）和 CK 和 alpha-SMA 的免疫组织化学染色，以研究肿瘤芽殖和纤维化癌基质。肿瘤芽殖分级为：Grade 1：0-4 个肿瘤芽殖，Grade 2：5-9 个芽殖，Grade 3：≥10 个芽殖，纤维化癌基质的性质分为成熟、中间和不成熟。
在分析的 45 例病例中，高分化鳞状细胞癌（WDSCC；Grade 1）占 42.22%（19 例），中分化鳞状细胞癌（MDSCC；Grade 2）和低分化鳞状细胞癌（PDSCC；Grade 3）分别占 48.89%（22 例）和 8.89%（4 例）。肿瘤芽殖在 33.3%（Grade 1）的病例中出现 0-4 个芽殖，在 48.9%（Grade 2）的病例中出现 5-9 个芽殖，在 17.8%（Grade 3）的病例中出现≥10 个芽殖。评估肿瘤基质时，中间基质占 51.1%，成熟基质占 37.8%，11.1%显示不成熟基质。组织学上，Grade 1 病例中<5 个芽殖占 47.4%，而 Grade 3 病例中≥10 个芽殖占 75.0%，具有统计学意义（p=0.021）。然而，T&N 分期与肿瘤芽殖之间的关联没有统计学意义。WDSCC 的基质明显比 MDSCC 和 PDSCC 更成熟，而 MDSCC 显示中间和不成熟基质的比例更高（p<0.001）。相比之下，纤维化基质与肿瘤芽殖之间没有显著相关性（p=0.076）。此外，比较了纤维化基质与肿瘤芽殖，但未发现显著相关性（p=0.076）。
本研究揭示了肿瘤芽殖、癌症基质和 WHO 肿瘤分级之间的显著联系。因此，在 HNSCC 病例中评估这些因素可以作为有价值的组织学预后指标，有助于治疗计划和预后评估。
