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. 2025 Mar;47(3):856-866.
doi: 10.1002/hed.27979. Epub 2024 Oct 30.

Evaluating Depth of Invasion as a Continuous Prognostic Factor in Oral Squamous Cell Carcinoma

Nofar Edri  1   2 , Dean Dudkiewicz  1   2 , Dan Yaniv  1   2 , Amit Ritter  1   2 , Yulia Strenov  2   3 , Aviram Mizrachi  1   2 , Gideon Bachar  1   2 , Thomas Shpitzer  1   2 , Eyal Yosefof  1   2   4
Affiliations

Evaluating Depth of Invasion as a Continuous Prognostic Factor in Oral Squamous Cell Carcinoma

Nofar Edri et al. Head Neck. 2025 Mar.

Abstract

Background: Depth of invasion (DOI) has a significant clinical impact on the staging system of oral squamous cell carcinoma (OSCC). We aimed to compare the prognostic impact of treating DOI as a continuous variable rather than a categorical one.

Methods: A retrospective review of 277 OSCC patients surgically treated in a tertiary care center from 2000 to 2020, with a minimum 2-year follow-up. The analyses were performed using Cox and logistic regression.

Results: DOI as a continuous variable significantly predicted mortality in both univariate (p < 0.001) and multivariate (p < 0.001) analyses. It was also a significant predictor of locoregional recurrence (multivariate p = 0.039) and occult lymph node metastasis (univariate p = 0.005, multivariate p = 0.04). Categorical analysis failed to demonstrate the same significance.

Conclusions: DOI as a continuous factor rather than a categorical one is significantly associated with mortality, locoregional recurrence, and occult lymph node metastasis. This innovative approach promotes personalized risk stratification and better decision-making.

Keywords: depth of invasion; occult lymph node metastais; oral squamous cell carcinoma; overall survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(A) mortality from disease rate after 1 year by DOI (measured in centimeters). (B) mortality from disease rate after 2 years by DOI (measured in centimeters).
FIGURE 2
FIGURE 2
(A) Locoregional recurrence rate after 1 year by DOI (measured in centimeters). (B) Locoregional recurrence rate after 2 years by DOI (measured in centimeters).
FIGURE 3
FIGURE 3
Probability of occult lymph node metastases by DOI (measured in centimeters).
See this image and copyright information in PMC

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