Interpretation of Epidermal Growth Factor Receptor Status in Microscopic Tumor-Free Surgical Margins and Lymph Nodes in Patients with Oral Squamous Cell Carcinoma: An Analysis of 125 Margins.

BACKGROUND

Squamous cell carcinomas are the most common type of oral cancer contributing for around 90%. The overall survival is below 50% for these patients. There is a requirement for a non-invasive marker to predict the prognosis. The epidermal growth factor (EGF) and their receptors (EGFR, ErbB-1) are not only documented to play a critical and an influential role in cell growth and differentiation in normal/healthy tissues, but may also plays an important role in malignant disease progression and tumorigenesis.

OBJECTIVE

This study was done to find the significance of EGF receptor expression on microscopic free tumour margins and lymph nodal margins to predict the survival of the patient in a 2-year follow-up.

MATERIALS AND METHODS

A prospective cohort study of 25 patients was performed in biopsy proven oral squamous cell carcinoma patients who reported to our department from July 2017 to June 2019. The data were collected from their histopathological report, they were- pTNM staging, surgical margins (superior and inferior, anterior, posterior), nodal status and scoring of EGFR expression on wax blocks was done. Total of 125 wax blocks were analysed for the study. Follow-up of 2 years were recorded in the study to evaluate the survival of the patients.

RESULT

The expression of EGFR on microscopic tumour-free surgical margins and lymph nodes was value 0.023 which was statistically significant. The level of significance between EGFR and status of patients after 2-year follow-up was having value 0.031. Out of 25 patients, 5 patients were dead at a 2-year follow-up. Out of these 5 patients who were dead, 3 patients had a local recurrence and 2 patients had distant metastasis.

CONCLUSION

This cohort study concludes that EGFR is an important prognostic marker and must be analysed in all microscopic tumour-free margins and lymph nodes in advanced oral squamous cell carcinomas to predict the local recurrences affecting the survival of the patients and the need for addition of anti-EGFR agents in adjuvant treatment. Since the sample size is small, large scale studied must be done to validate the need for adding anti-EGFR agents in adjuvant treatment to improve the survival of patients.