Comparison of histopathological and clinical prognostic factors of oral squamous cell carcinomas

Abstract

Introduction, aim: Oral carcinomas are a significant component of human tumors and their incidence has increased in recent years. The most important histopathological factors affecting the treatment and prognosis of oral squamous cell carcinoma include localization, size, depth of invasion, histological type, tumor grade, intravascular and perineural invasion, positivity of surgical margins and tumor to margin distance, metastases in regional lymph nodes, extracapsular spreading and type of bone invasion. The aim of the study is to evaluate the relationship of selected histopathological and clinical parameters to the stage of cancer in the group of patients operated for oral squamous cell carcinoma. Methods: The group consisted of 42 patients (33 males and 9 females) operated for oral squamous cell carcinoma in 2005-2015, where the reconstruction phase of the operation was subsequently performed. Histological samples have been evaluated prospectively (after 2013) or re-evaluated with revision of pathological findings in biopsies prior to 2013. The values of clinical and pathological parameters were analyzed by the methods of descriptive statistics and their correlation was compared by Pearson χ2 test (Statistica 12, StatSoft), p values < 0.05 were considered statistically significant. Results: The most common tumor location was at the floor of mouth and tongue, with spread to the lower jaw alveolar process. The treatment was initiated in stage II in 26% of patients, in stage III in 19% and in stage IV in 55%. With increasing tumor stage, there were higher rates of nodal metastases (p = 0.00004) extracapsular tumor spreading (p = 0.004), maximal depth of invasion, higher tumor grade (p = 0.001), higher recurrence rate (p = 0.039) and mortality (p = 0.003). In stage III and IV, a trend of increased frequency of perineural tumor spreading has been noted (p = 0.07). The local tumor recurrence in stage IV was associated with tumor-related death in 92,85% of cases and in the majority of cases with previous positive surgical margin. Conclusion: In the oncology of oral carcinoma, close cooperation of all specialists involved in the diagnosis and treatment of these tumors (dentist, surgeon, pathologist, oncologist) is important. Histopathological examination of oral cancers is an important part of comprehensive patient care and provides the most important prognostic information. The goal of proper planning of the entire surgical procedure is to completely remove the tumor with healthy surgical margins as well as good aesthetic and functional results.

Keywords

• head and neck squamous cell carcinoma
• oral cancer
• prognostic factors