Indian Journal of Pathology and Microbiology
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Year : 2020  |  Volume : 63  |  Issue : 4  |  Page : 527-533

Worst pattern of invasion – type 4 (WPOI-4) and Lymphocyte host response should be mandatory reporting criteria for oral cavity squamous cell carcinoma: A re-look at the American Joint Committee of Cancer (AJCC) minimum dataset

1 Department of Oncopathology, Tata Medical Centre, Kolkata, West Bengal, India
2 Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India

Correspondence Address:
Paromita Roy
Senior Consultant, Department of Oncopathology, Tata Medical Centre, 14 MAR (E.W), Newtown, Kolkata-700 156, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_662_19

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Background: A proportion of early-stage node-negative oral squamous carcinoma patients fail despite complete surgical resection. Adjuvant treatment in early oral cancer is controversial and is often individualized based on stage, depth, and margin status. Aims: We reviewed various histological markers in pT1/T2N0 cases, resected upfront with elective nodal dissection, with an emphasis on tumor-tissue interface characteristics of the worst pattern of invasion (WPOI), tumor cell nest size (sCNS), budding and lymphocytic host response (LHR), to assess their prognostic significance. Materials and Methods: Archived blocks of 95 cases were reviewed. Tumor stage, grade, size, depth of invasion, lymphovascular, and perineural invasion, WPOI, LHR, sCNS, and tumor bud (single cells or <5 cell clusters) score were recorded. Statistical Analysis: Prognostic significance was statistically analyzed using SPSS software version 20. Results: Depth of invasion (P = 0.008), WPOI- 4 and 5 (P = 0.033), sCNS (<5 cells) at tumor interface (P = 0.010), high bud count (≥3 buds/40 × hpf) (P = 0.021) and poor LHR (P = 0.019) correlated significantly with poor disease-free survival on univariate analysis. However, on multivariate analysis only LHR and WPOI-4 (that is presence of small cell nests or buds) were significant, with high hazard ratio of 4.351 (95% CI 1.290–14.676, P = 0.018) and 5.019 (95% CI 1.212–20.789, P = 0.026), respectively. Conclusion: We propose mandatory reporting of WPOI-4 at the tumor interface and absence of LHR, as significant markers of poor prognosis in early-stage oral cavity squamous carcinoma.

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