PDF(Pubmed)
Abstract：
Although Worst pattern of invasion (WPOI) is one of the histopathological (HP) markers that has been utilized in risk stratification of oral squamous cell carcinoma (OSCC) patients, its potential as an independent predictive factor for lymph node metastasis (LNM) and prognosis is least analyzed. Aim of the study is to analyze the relationship of various HP parameters to WPOI, their propensity for lymph node metastasis and prognostic value. This retrospective study included 140 patients diagnosed with resectable OSCC who underwent definitive surgery. Multiparametric HP risk assessment was done on the postoperative specimen and patients were categorized as low-risk WPOI (Type 1-3), and high-risk group (type 4 and 5). After categorization, 36.1% patients had low-risk WPOI and 63.9% had high-risk WPOI. Significant association was noted between WPOI and patient\'s age (p = 0.001), nodal stage (p = 0.001), lymphovascular invasion (LVI) (p = 0.006) and neural invasion (p = 0.001). 87% patients with nodal metastasis had high risk WPOI. LVI (p = 0.014) and WPOI (p < 0.001) had significant predictive role in LNM. High-risk WPOI and bone involvement were found to be predictive factors for overall survival, and only high risk WPOI had strong correlation with disease free survival having significant poor prognosis. Analyzing WPOI is essential in reporting HP specimens in OSCC. High-risk WPOI can act as an independent predictor for LNM, early recurrence and poor prognosis. Incorporation of WPOI into TNM staging is recommended to improve clinician\'s ability to prognosticate and individualize treatment strategies.
摘要：
尽管最恶劣的侵袭模式（WPOI）是已用于口腔鳞状细胞癌（OSCC）患者风险分层的组织病理学（HP）标志物之一，其作为淋巴结转移(LNM)和预后的独立预测因子的可能性最小。研究的目的是分析各种HP参数与WPOI的关系，他们的淋巴结转移倾向和预后价值。这项回顾性研究包括140例诊断为可切除OSCC并接受确定性手术的患者。对术后标本进行多参数HP风险评估，并将患者归类为低风险WPOI（1-3型），和高危人群（4型和5型）。分类后，36.1%的患者患有低危WPOI，63.9%的患者患有高危WPOI。WPOI与患者年龄之间存在显着相关性（p=0.001），结节阶段(p=0.001)，淋巴管浸润（LVI）（p=0.006）和神经浸润（p=0.001）。87％的淋巴结转移患者具有高风险的WPOI。LVI(p=0.014)和WPOI(p<0.001)在LNM中具有显著的预测作用。高风险WPOI和骨受累被发现是总生存率的预测因素。只有高风险的WPOI与无疾病生存有很强的相关性，预后较差。分析WPOI对于报告OSCC中的HP标本至关重要。高风险WPOI可以作为LNM的独立预测因子，早期复发和预后不良。建议将WPOI纳入TNM分期，以提高临床医生预测和个性化治疗策略的能力。
