A Study of Histological and Clinical Parameters and Their Correlation With Lymph Node Metastasis and Two-Year Survival in 50 Cases of Oral Squamous Cell Carcinoma

Abstract

Introduction: Oral squamous cell carcinoma (OSCC) is one of the most prevalent malignant neoplasms in South Asia and a major public health problem in India. The purpose of the study was to identify correlations among various clinicopathological parameters of OSCC in a tertiary care center in the Eastern Uttar Pradesh population of North India. The study is imperative due to the scarcity of available data from this region.

Methodology: A retrospective observational study was conducted on the cases received in the Department of Pathology over the period of January 2021 to December 2021. The study analyzed cases of OSCC, focusing on various factors such as age, gender, habits, tumor site, tumor size, differentiation, tumor-stroma ratio, tumor-infiltrating lymphocytes, tumor budding, worst pattern of invasion, depth of invasion, perineural invasion, lymphovascular invasion, underlying bone and overlying skin involvement, regional lymph node metastasis, and overall two-year survival.

Results: The mean age of the patients was 47.80 ± 12.48 years, and the male-to-female ratio was 15.6:1. Buccal mucosa was the most frequently affected site followed by the tongue. Fifty-six percent of cases reported with a history of tobacco abuse. Thirty-six percent of the patients had regional lymph node metastasis and exhibited a strong association with younger age, substance abuse, higher tumor size, tongue as a site, moderate-to-poor tumor differentiation, low tumor-infiltrating lymphocytes, and higher perineural and lymphovascular invasion. Moreover, at the end of the two-year survival analysis, 34% of patients succumbed to the disease. Overall survival was observed to be significantly better with <2 cm maximum tumor size, well-differentiated tumor morphology, higher tumor-infiltrating lymphocytes, and no nodal metastasis.

Conclusions: The study highlights the intricate correlations of various histopathological factors in OSCC, shedding light on their potential implications for prognosis.

Keywords: histopathological spectrum; lymph node metastasis; oral squamous cell carcinoma; prognostic markers; survival rate.

Figure 1. Hematoxylin and eosin: x400 squamous cell carcinoma - well differentiated.

Figure 2. Hematoxylin and eosin stain (x400): tumor budding (high risk).

Figure 3. Hematoxylin and eosin stain (x400): tumor-infiltrating lymphocytes (high infiltration).

Figure 4. Hematoxylin and eosin stain (x200): tumor-stroma ratio (stroma poor).

Figure 5. Hematoxylin and eosin (x400): perineural invasion.

Figure 6. Hematoxylin and eosin stain (x400): lymphovascular invasion.