Background

The majority of oral cavity cancers arise in the oral tongue. The aim of this study was to evaluate the prognostic value of tumor budding in oral tongue squamous cell carcinoma, both as a separate variable and in combination with depth of invasion. We also assessed the prognostic impact of the 8th edition of the American Joint Committee on Cancer’s TNM classification (TNM8), where depth of invasion (DOI) supplements diameter in the tumor size (T) categorization.

Methods

Patients diagnosed with primary oral tongue squamous cell carcinoma were evaluated retrospectively. Spearman bivariate correlation analyses with bootstrapping were used to identify correlation between variables. Prognostic value of clinical and histopathological variables was assessed by Log rank and Cox regression analyses with bootstrapping using 5-year disease specific survival as outcome. The significance level for the hypothesis test was 0.05.

Results

One-hundred and fifty patients had available material for microscopic evaluation on Hematoxylin and Eosin-stained slides and were included in the analyses. Reclassification of tumors according to TNM8 caused a shift towards a higher T status compared to the previous classification. The tumor budding score was associated with lymph node metastases where 23% of the patients with low-budding tumors had lymph node metastases, compared with 43% of those with high-budding tumors. T-status, lymph node status, tumor budding, depth of invasion, and the combined tumor budding/depth of invasion score were all significantly associated with survival in univariate analyses. In multivariate analyses only N-status was an independent prognosticator of survival.

Conclusion

Reclassification according to TNM8 shifted many tumors to a higher T-status, and also increased the prognostic value of the T-status. This supports the implementation of depth of invasion to the T-categorization in TNM8. Tumor budding correlated with lymph node metastases and survival. Therefore, information on tumor budding can aid clinicians in treatment planning and should be included in pathology reports of oral tongue squamous cell carcinomas.

中文翻译：

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肿瘤发芽评分可预测口腔鳞状细胞癌的淋巴结状态，应纳入病理报告中

背景

大多数口腔癌发生在口腔舌中。这项研究的目的是评估肿瘤发芽在口腔舌鳞状细胞癌中的预后价值，既可作为单独变量，也可与浸润深度相结合。我们还评估了美国癌症联合委员会第8版TNM分类（TNM8）的预后影响，其中浸润深度（DOI）补充了肿瘤尺寸（T）分类中的直径。

方法

回顾性评估诊断为原发性口腔舌鳞状细胞癌的患者。使用自举的Spearman双变量相关性分析用于识别变量之间的相关性。临床和组织病理学变量的预后价值通过对数秩和Cox回归分析以5年特定疾病生存期作为结果进行自举评估。假设检验的显着性水平为0.05。

结果

一百五十名患者拥有可用材料对苏木精和曙红染色的载玻片进行显微镜评估，并包括在分析中。与之前的分类相比，根据TNM8对肿瘤的重新分类导致向更高的T状态转移。肿瘤出芽分数与淋巴结转移有关，其中低发芽肿瘤患者中有23％发生淋巴结转移，而高发芽肿瘤患者中则有43％。在单变量分析中，T状态，淋巴结状态，肿瘤出芽，浸润深度以及合并的肿瘤出芽/浸润深度得分均与生存率显着相关。在多变量分析中，只有N状态是生存的独立预后因子。

结论

根据TNM8进行的重新分类将许多肿瘤转移到较高的T状态，也增加了T状态的预后价值。这支持在TNM8中对T分类进行入侵深度的实现。肿瘤萌发与淋巴结转移和生存有关。因此，有关肿瘤发芽的信息可帮助临床医生制定治疗计划，并且应包括在口腔舌鳞状细胞癌的病理报告中。