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. 2023 Sep;17(3):679-687.
doi: 10.1007/s12105-023-01571-9. Epub 2023 Jul 24.

Significance of Worst Pattern of Invasion-5 in Early-Stage Oral Cavity Squamous Cell Carcinoma

Shima Mohamed  1   2 , Hadeel Jawad  1   3 , Ryan O' Sullivan  4 , Deirdre Callanan  4   5 , Patrick Sheahan  4   6   5 , Linda Feeley  7   8
Affiliations

Significance of Worst Pattern of Invasion-5 in Early-Stage Oral Cavity Squamous Cell Carcinoma

Shima Mohamed et al. Head Neck Pathol. 2023 Sep.

Abstract

Background: There is an ongoing need to identify pathologic prognosticators in early-stage oral cavity squamous cell carcinoma (OCSCC) to aid selection of patients who may benefit from adjuvant treatment. The objective of this study was to evaluate the prognostic ability of worst pattern of invasion-5 (WPOI-5) defined by the presence of satellite nodules, extratumoural perineural invasion (PNI) and/or extratumoural lymphovascular space invasion (LVI) in low-stage, node negative OCSCC.

Methods: This was a retrospective study of 160 patients with T1/T2N0 tumours staged using TNM7 treated surgically. Histology of the primary tumour was re-reviewed as appropriate to assess for the presence of WPOI-5 parameters. Univariate and multivariate analysis assessing impact of pathological features on survival outcomes was performed.

Results: On univariate analysis, WPOI-5 and its 3 constituent components of satellite nodules, extratumoural PNI and extratumoural LVI were all significantly associated with disease-specific survival (DSS) and overall survival (OS). On multivariate analysis, satellite nodules (odds ratio 6.61, 95% CI 2.83-15.44, p < 0.0001) and extratumoural LVI (odds ratio 9.97, 95% CI 2.19-45.35, p = 0.003) were independently associated with OS. Postoperative radiotherapy (odds ratio 0.40, 95% CI 0.19-0.87, p = 0.02) and non-tongue subsite (odds ratio 3.03, 95% CI 1.70-5.39, p = 0.0002) were also significantly associated with OS on multivariate analysis.

Conclusion: Satellite nodules and extratumoural LVI correlated significantly with survival outcomes in our early-stage OSCC cohort. Further study is required to investigate the benefit of adjuvant treatment in these cases and to ascertain if WPOI-5 parameters including satellite nodules should be mandatory reporting data elements.

Keywords: Head and neck cancer; Oral cancer; Prognosis; Squamous cell carcinoma; Worst pattern of invasion.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Low power (1.5×) H&E image showing main tumour bottom right and a satellite focus > 1 mm away at the black arrow
Fig. 2
Fig. 2
DSS and OS according to PNI (absent, solid line; intratumoural dotted line; extratumoural, dashed line)
Fig. 3
Fig. 3
DSS and OS according to LVI (absent, solid line; intratumoural dotted line; extratumoural, dashed line)
Fig. 4
Fig. 4
DSS and OS according to satellite nodules (absent, blue line; present, green line)
Fig. 5
Fig. 5
DSS and OS according to WPOI-5 (absent, blue line; present, green line)
See this image and copyright information in PMC

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