Worst pattern of invasion: A prognostic indicator in early-stage oral tongue cancer: A single-center cohort study

The goal of prognostic studies in early-stage oral tongue cancer is to identify the subset of patients at risk of a poor prognosis and thus need more aggressive treatment, such as multimodality therapy. This study analyses the prognostic significance of worst pattern of invasion (WPOI) in a unique population of pathologically proven node-negative early-stage patients to see if the WPOI was a prognostic marker that may help guide adjuvant therapy options. We analyzed prospectively collected data from 192 oral squamous cell carcinoma (OSCC) patients treated between 2017 and 2021. Patients underwent curative surgery with or without adjuvant therapy. The study included only pathologically proven early-stage tongue squamous cell carcinoma (pathological T1-T2) with node-negative (N0) and complete histological details such as WPOI, Lymphocyte host response (LHR), Perinueral invasion (PNI), and Lymphovascular invasion (LVI). Statistical analysis was done using chi-square, cox multivariate analysis, and Kaplan-Meier survival analysis. In 192 subjects with a mean follow-up of 22 months, there were 39 recurrences. We had 20 (15.74%) patients in non-aggressive WPOI and 19 (29.23%) in aggressive WPOI groups. TNM staging and WPOI are significantly associated with postoperative recurrence (p-value 0.029 and 0.019 respectively). However, PNI (p-value-0.954), LVI (p-value - 0.7490 and adjuvant therapy (p-value-0.733) were found to have no significant association. Radiation has no role in patients with aggressive WPOI and more as there is no decrease in postoperative recurrences (p-value 0.85). WPOI is an independently significant prognostic factor for postoperative recurrences. This study also found that adjuvant radiation therapy did not help in reduction of post-operative recurrences.