J Korean Assoc Oral Maxillofac Surg.  2022 Oct;48(5):249-258. 10.5125/jkaoms.2022.48.5.249.

Prognosis of tongue squamous cell carcinoma associated with individual surgical margin and pathological features

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
  • 2Department of Oral Pathology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea

Abstract

The specific muscular structure of the tongue greatly affects margin shrinkage and tumor invasion, making the optimal surgical margin controversial. This study investigated surgical margin correlated prognosis of TSCC (tongue squamous cell carcinoma) according to margin location and its value, and the histopathologic factors which are suggestive of tumor invasion. And we would like to propose defining of the surgical margin for TSCC via prognosis according to location and margin values. We reviewed 45 patients diagnosed with TSCC who visited Seoul National University Dental Hospital (SNUDH) (Seoul, Republic of Korea) from 2010 to 2019, who were managed by a single surgical team. Patient clinical and pathological data of patients were retrospectively reviewed, and in 36 out of 45 patients, the pathologic parameters including the worst pattern of invasion (WPOI) and tumor budding were investigated via diagnostic histopathology slide reading. When standardized with as 0.25 cm anterior margins, as 0.35 cm deep margin, there was no significant difference in disease specific survival (DSS) or loco-regional recurrence-free survival (LRFS). Additionally, there was a non-significant difference in DSS and LRFS at the nearest margin of 0.35 cm (PDSS =0.276, PLRFS =0.162). Aggressive WPOI and high tumor budding showed lower survival and recurrence-free survival, and there were significant differences in close margin and involved margin frequencies. In TSCC, the value and location of the surgical margin did not have a significant relationship with prognosis, but WPOI and tumor budding suggesting the pattern of muscle invasion affected survival and recurrence-free survival. WPOI and tumor budding should be considered when setting an optimal surgical margin.

Keyword

Oral tongue squamous cell carcinoma; Surgical margin; Worst pattern of invasion; Tumor budding

Figure

  • Fig. 1 Schematic drawing showing margin shrinkage of the tongue mass after detachment. When tumor mass was dissected from adjacent tissue, tissue shrinkage occurred. Shrinkage occurred differently according to tissue composition and anatomical site, and varied between the tongue, other oral cavities, and the medial and lateral sides of tongue.

  • Fig. 2 Pattern of invasion (POI) classified into 5 categories. Type 1 shows a broad pushing front. Type 2 shows a finger-like front (A, ×20 magnification, red arrows). Type 3 shows a larger cell group (>15-cell island, red arrow) (B, ×10 magnification). Type 4 shows smaller cell groups (≤15-cell island, red arrows), strands, or even single cells (within 1 mm from main tumor) (C, ×20 magnification). Type 5 shows satellite patterns that detached the island (red arrow) from the main tumor or island by >1 mm (D, ×10 magnification), large cell island >1 mm away from the main tumor.

  • Fig. 3 Histologic finding of tumor budding at invasive front area. Tumor budding was defined as a single cancer cell or a cluster of <5 cancer cells in the stroma of the invasive front (A, graded as low: 0-4 buds, intermediate or high: ≥5 buds, ×40 magnification). Posterior surgical margin of tongue mass, dyed green, showing distance from green pointed tumor margin more than 13.0 mm (B, ×40 magnification). C. Involved surgical deep margin (red arrow) of tongue, dyed with green.

  • Fig. 4 Receiver operating characteristic curve of cut-off value with LRFS (loco-regional recurrence-free survival). Anterior margin showed significant value (0.25 cm, P=0.013), but also a downward trend compared with the reference line, indicating low utility.

  • Fig. 5 Kaplan–Meier curve of DSS (disease specific survival) according to nearest margin 0.35 cm, worst pattern of invasion (WPOI), tumor budding. For disease-specific survival, the group with the nearest margin greater than 0.35 cm in the survival curve showed higher survival, but it was not statistically significant (P=0.276). And the non-aggressive WPOI group showed a 100% survival rate and showed a statistically significant difference compared with the aggressive WPOI group (P=0.03). Also, the group with low-tumor budding in the survival curve showed higher survival, but it was not statistically significant (P=0.271). Non-aggressive WPOI (WPOI types 1, 2, 3), aggressive WPOI (WPOI types 4, 5). Low tumor budding (less than 5 buds), high-tumor budding (≥5 buds). Buds defined as a single cancer cell or a cluster of less than 5 cancer cells in the stroma of the invasive front.

  • Fig. 6 Kaplan–Meier curve of loco-regional recurrence-free survival (LRFS) according to nearest margin 0.35 cm. In LRFS, the group with the margin nearest >0.35 cm in the recurrence-free survival curve showed higher recurrence-free survival, but it was not statistically significant (P=0.162), the group with non-aggressive worst pattern of invasion (WPOI) group showed higher recurrence-free survival in the curve (P=0.05), and the group with low-tumor budding had higher recurrence-free survival in the curve (P=0.024). Non-aggressive WPOI (WPOI types 1, 2, 3), aggressive WPOI (WPOI types 4, 5). Low tumor budding (less than 5 buds), high-tumor budding (≥5 buds). Buds defined as a single cancer cell or a cluster of less than 5 cancer cells in the stroma of the invasive front.


Reference

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