Elsevier

Oral Oncology

Volume 42, Issue 3, March 2006, Pages 229-239
Oral Oncology

Review
Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma

https://doi.org/10.1016/j.oraloncology.2005.05.008Get rights and content

Summary

Histopathological assessment of the surgical resection specimen continues to provide information that is central to determining the post-operative treatment needs and prognosis for an individual patient with oral/oropharyngeal squamous cell carcinoma. This review describes the prognostic value of histopathological features related to the primary tumour and the cervical lymph nodes, and considers their relative merits. In addition, a brief overview of more general patient factors is included. Throughout the review, guidance is offered on practical aspects of the histopathological assessment together with brief mention of potential inaccuracies. Emphasis is given also to the importance of the partnership between the surgeon and the pathologist, the need for standardisation during all stages of the histopathological assessment, and the value of accurate documentation of the findings.

Introduction

Although in recent years, numerous biological and molecular factors have been proposed as prognosticators in oral and oropharyngeal squamous cell carcinomas (OSCC), these have yet to impact on routine clinical care, and detailed histopathological staging of surgical resection specimens remains an important determinant of post-operative management and prognosis prediction. This review details histopathological prognosticators related to the primary tumour and the cervical lymph nodes, and considers their relative merits, and summarises the significance of distant metastases, general patient factors, and locoregional relapse.

Section snippets

Tumour site

The gradual decrease in the five-year survival for more posteriorly located tumours has been recognised for many years.1, 2 This association between tumour site and survival is largely explained by tumour site’s influence on nodal metastasis, and to a lesser extent, stage at presentation; histological grade and features of the advancing tumour front including the pattern of invasion and perineural invasion; vascular invasion; the surgeon’s ability to achieve clear resection margins, and the

Distant (systemic) metastases

Between 5% and 25% of OSCC patients have clinical evidence of distant metastases within two years of initial diagnosis.84 Traditionally, cases initially staged N2 or N3, and those with uncontrolled locoregional disease were thought to be most at risk,84 but more recent reports have shown ECS is the single best predictor.81, 82, 86 The mean survival following diagnosis of distant metastases is less than six months and 90% of cases are dead by two years.84

Additional prognostic features

The prognostic importance of general patient features is weak compared with the pathological extent and characteristics of the tumour but survival is reportedly associated with gender;12, 88, 89, 90, 91 age;12, 67, 89, 91, 92, 93, 94 geographical location;95 race;91 co-morbid conditions secondary to tobacco and alcohol abuse;12, 91, 96, 97 immune status;92, 98, 99 absence of usual risk factors;100, 101 and the development of second (and serial) primary tumours.89, 102, 103, 104 The evidence

Local and regional relapse

Local relapse—the re-appearance of SCC within the oral cavity/oropharynx—can be classified as a true recurrence developing from foci of tumour cells left in the operative site (persistent disease); or a new primary (metachronous) SCC developing from the mucosa adjacent to the operative site (often at the edge of the skin-flap used to reconstruct the surgical defect); or elsewhere within the mouth/oropharynx well away from the site of the first (index) tumour.5 True recurrences develop much

Peripheral epithelial dysplasia, multifocal carcinoma and second primary tumours

Both peripheral epithelial dysplasia and an index (first) tumour of multifocal origin are associated with an increased risk of second (and serial) primary tumours.5, 65 Second (and serial) primary SCCs have been reported in 7–33% of oral cancer patients.10, 108 The wide range probably reflects factors as diverse as the criteria for diagnosis and division from recurrent/persistent disease; the duration of the study; the extent of the follow-up clinical assessment; and the implementation and

The way ahead?

It is clear that the identification of accurate prognosticators in OSCC has been hampered by the relatively small number of cases of the disease, especially in any one treatment centre; the heterogeneity of clinical features such as the extent of the disease at presentation; and, in particular, by the lack of standard clinical, management and laboratory protocols combined with inconsistent recording and reporting of data. Even two of the well-established histological predictive factors—tumour

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