Depth of invasion (DOI) and pattern of invasion (POI) indicate tumor invasiveness of oral squamous cell carcinoma (OSCC). However, preoperative DOI evaluation is challenging, and the correlations between DOI and POI are unknown. We aimed to assess DOI and worst pattern of invasion (WPOI) in early-stage OSCC, and evaluate the preoperative predictive ability of biopsy pattern of invasion (BPOI) for WPOI and DOI. This retrospective study included n = 444 OSCC patients with pT1-2N0M0. The prognostic value of DOI, WPOI, and BPOI and the predictive prognostic option for WPOI and DOI by BPOI were assessed. WPOI (1–3 vs 4–5), but not BPOI, predicted the lowest survival rate and highest DOI. To evaluate the difference between WPOI and BPOI, we conducted a POI type-matching analysis of patients with BPOI1–4 and WPOI1–5. Based on each WPOI type, the false-prediction rates (FPR) of BPOI types 1 (n = 23), 2 (n = 89), 3 (n = 252), and 4 (n = 80) were 52.17%, 52.81%, 36.90%, and 0%, respectively. BPOI4 perfectly predict WPOI 4–5. As the false-predicted BPOI 1–2 was almost WPOI2–3 (79.7%), regardless of the existed FPR, patients with BPOI1–2 have longer survival and lower DOI than those with BPOI 4. However, this phenomenon was not observed in BPOI3, because all false-predicted BPOI3 were WPOI4–5 with a high DOI. We provide an alternative predictive prognostic option for WPOI and DOI by evaluating BPOI during OSCC surgical planning, with the recommendation of conservative treatment in patients with BPOI 1–2.

侵袭深度（DOI）和侵袭模式（POI）表明口腔鳞状细胞癌（OSCC）的肿瘤侵袭性。然而，术前 DOI 评估具有挑战性，DOI 和 POI 之间的相关性尚不清楚。我们旨在评估早期 OSCC 中的 DOI 和最坏浸润模式 (WPOI)，并评估活检浸润模式 (BPOI) 对 WPOI 和 DOI 的术前预测能力。这项回顾性研究包括n= 444 名患有 pT1-2N0M0 的 OSCC 患者。评估了 DOI、WPOI 和 BPOI 的预后价值以及 BPOI 对 WPOI 和 DOI 的预测预后选项。WPOI（1-3 对 4-5），而不是 BPOI，预测最低的存活率和最高的 DOI。为了评估 WPOI 和 BPOI 之间的差异，我们对 BPOI1-4 和 WPOI1-5 患者进行了 POI 类型匹配分析。基于每种 WPOI 类型，BPOI 类型 1 ( n = 23)、2 ( n = 89)、 3 ( n = 252) 和 4 ( n= 80) 分别为 52.17%、52.81%、36.90% 和 0%。BPOI4 完美地预测了 WPOI 4-5。由于错误预测的 BPOI 1-2 几乎是 WPOI2-3（79.7%），无论是否存在 FPR，BPOI1-2 患者比 BPOI 4 患者有更长的生存期和更低的 DOI。但是，这种现象在BPOI3，因为所有错误预测的 BPOI3 都是具有高 DOI 的 WPOI4-5。我们通过在 OSCC 手术计划期间评估 BPOI 为 WPOI 和 DOI 提供了另一种预测预后选择，并建议对 BPOI 1-2 的患者进行保守治疗。