Cervical lymph node metastasis from early-stage squamous cell carcinoma of the oral tongue

A robust and interpretable gene signature for predicting the lymph node status of primary T1/T2 oral cavity squamous cell carcinoma

Oral cavity squamous cell carcinoma (OSCC) affects more than 30 000 individuals in the United States annually, with smoking and alcohol consumption being the main risk factors. Management of early-stage tumors usually includes surgical resection followed by postoperative radiotherapy in certain cases. The cervical lymph nodes (LNs) are the most common site for local metastasis, and elective neck dissection is usually performed if the primary tumor thickness is greater than 3.5 mm. However, postoperative histological examination often reveals that many patients with early-stage disease are negative for neck nodal metastasis, posing a pressing need for improved risk stratification to either avoid overtreatment or prevent the disease progression. To this end, we aimed to identify a primary tumor gene signature that can accurately predict cervical LN metastasis in patients with early-stage OSCC. Using gene expression profiles from 189 samples, we trained K-top scoring pairs models and identified six gene pairs that can distinguish primary tumors with nodal metastasis from those without metastasis. The signature was further validated on an independent cohort of 35 patients using real-time polymerase chain reaction (PCR) in which it achieved an area under the receiver operating characteristic (ROC) curve and accuracy of 90% and 91%, respectively. These results indicate that such signature holds promise as a quick and cost effective method for detecting patients at high risk of developing cervical LN metastasis, and may be potentially used to guide the neck treatment regimen in early-stage OSCC.

Epidemiological and Histopathological Aspects of Tongue Squamous Cell Carcinomas-Retrospective Study

Tongue squamous cell carcinoma is one of the most commonly diagnosed intraoral squamous cell carcinomas (25-40%), being considered an aggressive form of squamous cell carcinoma, as it is most commonly associated with lymph node metastases and the survival rate at five years is below 50%. In according with these data, we have proposed in this study to individualize an epidemiological and histopathological profile of the patients with such oral cancers, diagnosed and treated in the Oral and Maxillofacial Surgery Clinic and in the Otolaryngology Surgery Clinic of the Emergency Clinical County Hospital Craiova, between 2015-2017. The cases were histopathologically reassessed according to the latest WHO classification of head and neck tumors, the variables of interest being the age of the patients, the gender, the lesion topography, the histological subtype, the degree of tumor differentiation, the pTNM stage, the resection margin status and the Brandwein-Gensler prognostic score. Thus, we recorded an average age of 55.81±14.98 tongue cancer development, 65% of the casuistry being diagnosed during the 7th and 6th decades, with a slight prevalence in men, with development in two thirds of cases in the mobile portion of the tongue. Histopathologically, conventional forms of squamous cell carcinoma prevailed (53.7%), followed by varieties: acantholytic (26%), basaloid (13%), sarcomatoid (5.45%) and verrucous (1.85%). Moderate differentiated forms prevailed (44.44%), half of the cases falling within the moderate degree of Brandwein-Gensler's histological risk score and two thirds were diagnosed in pTNM stage II and III of the disease, and a quarter of the cases having the margins invaded.

Effects of lidocaine and the inclusion complex with 2-hydroxypropyl-β-cyclodextrin on cell viability and proliferation of oral squamous cell carcinoma

OBJECTIVES

Squamous cell carcinoma (SCC) is a malignant disease that affects the oral cavity. Lidocaine has shown antiproliferative and cytotoxic activity on several cell types. The rapid dispersion is a limitation issue; however, the complexation in cyclodextrin improved pharmacological features and modified the drug release. This study investigated the effects of lidocaine (lido) complexed with 2-hydroxypropyl-β-cyclodextrin (HP-β-CD-lido) on cell viability and proliferation of human tongue squamous cell carcinoma SCC9 and SCC25.

METHODS

The complex formation was confirmed by differential scanning calorimetry (DSC) and scanning electron microscopy (SEM). Cells SCC9 and SCC25 were exposed to lido and HP-β-CD-lido (40-4000 μm), and the effects on cell viability (MTT) and antiproliferative activity (SRB) were tested.

KEY FINDINGS

Differential scanning calorimetry and SEM results demonstrated the occurrence of host-guest interaction. Lido and HP-β-CD-lido (4000 μm) significantly reduced the viability of SCC9 cells to 83% and 63%, respectively. The viability of SCC25 treated with lido, and HP-β-CD-lido (4000 μm) was 71% and 44%, respectively. Lido (4000 μm) reduced the proliferation of SCC9 and SCC25 to 39.5% and 23.7%, respectively. HP-β-CD-lido (4000 μm) was cytotoxic for both cell lines.

CONCLUSIONS

HP-β-CD was able to potentiate the in vitro cytotoxic effects of lidocaine on human squamous cell carcinoma.

Optical lymph node detection system: A practical device to assist lymph node location in neck resection specimens

The status of lymph node (LN) metastasis, including the number and location of positive LNs, is a significant prognostic factor for oral squamous cell carcinoma (OSCC). Therefore, knowing the number and location of positive LNs is essential for prognosis. However, surgeons often have difficulty locating LNs. In the present study a practical device to improve the location of LNs in neck resection specimens was intoduced: the optical lymph nodes detection system (OLNDS). With the assistance of the OLNDS LNs were easier to locate and a significantly higher number of LNs were identified (P=0.006). The false detection rate was also significantly reduced compared with the traditional method (P=0.0034). The OLNDS was observed to be a valuable adjunct to the traditional method and may be useful for studying the value of LN metastasis in OSCC prognosis.

Histologic assessment of tumor budding in preoperative biopsies to predict nodal metastasis in squamous cell carcinoma of the tongue and floor of the mouth

BACKGROUND

In squamous cell carcinoma (SCC) of the tongue and the floor of the mouth (FOM), it is important to predict lymph node metastasis, including occult metastasis, before operating. The purpose of this study was for us to determine practical histopathologic parameters as predictive factors for lymph node metastasis in preoperative SCC biopsy specimens.

METHODS

We examined 91 cases of SCC for conventional histopathologic assessment and a new factor, tumor budding, and their relationship with lymph node metastasis.

RESULTS

Significant factors via univariate analysis (p < .01) were budding (score ≥3) and tumor depth (≥3 mm) and these were associated with lymph node metastasis. Moreover, both budding and tumor depth significantly correlated with relapse-free survival; however, evaluating biopsy specimens often proved inaccurate for predicting true tumor depth of cancer invasion.

CONCLUSION

Tumor budding using immunohistochemistry for cytokeratin should be added to routine histologic assessments as a new criterion factoring into the decision as to whether neck dissection is indicated. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1582-E1590, 2016.

Clinicopathological features and prognostic implications of Raf kinase inhibitor protein downregulation in tongue squamous cell carcinoma

Raf kinase inhibitor protein (RKIP) is recognized as a suppressor of metastasis, and the downregulation of RKIP is associated with aggressive events and a poor outcome in a variety of solid tumors. However, the clinical relevance of RKIP expression in tongue squamous cell carcinoma (TSCC) remains unclear. In the present study, the expression of RKIP in 85 pairs of TSCC and corresponding adjacent non-cancerous tissues, 30 matched metastatic lesions from the cervical lymph nodes and 32 oral leukoplakia samples were assessed using immunohistochemical methods. The association between RKIP expression and clinicopathological features was then evaluated. Kaplan-Meier survival analysis and Cox proportional hazards model were used to estimate the effect of RKIP expression on the survival time of patients with TSCC. The results revealed that RKIP expression was dramatically downregulated in TSCC, and to an even greater extent in metastatic lesions. RKIP downregulation was significantly associated with the presence of lymphatic metastasis and the clinical stage of TSCC. Furthermore, patients with low RKIP expression demonstrated a significantly shorter overall survival time. Multivariate analysis indicated that RKIP expression may be an independent prognostic factor in TSCC. In conclusion, the present findings indicate that the lack of RKIP expression is of clinical significance and may serve as a prognostic biomarker in TSCC.

Squamous cell carcinoma of the oral tongue: histopathological parameters associated with outcome

The purpose of this study was to investigate the applicability of the histological risk assessment model proposed by Brandwein-Gensler et al. in a cohort of oral tongue squamous cell carcinoma (OTSCC) patients treated with definitive surgery. We also examined the impact of additional histopathological features on disease acceleration. The cases of 49 OTSCC patients attending our institution between 1995 and 2009, who underwent definitive surgical resection followed by adjunct chemoradiotherapy when indicated, were reviewed retrospectively. Surgical resection specimens and complete clinical and demographic data were available for these patients; follow-up was at least 6 months. In this cohort we only identified a correlation between gender and the histopathological risk model score (P<0.001). With regard to clinical and demographic data, histopathological parameters, and disease status at last follow-up, we identified significant correlations between disease status and (1) grade of differentiation (P=0.0086), and (2) keratin score (P=0.026). We found no significant correlations between the histopathological risk assessment model and disease progression or outcomes, with the exception of gender (P<0.0001). Grade of differentiation, keratin score, and the lymphocytic host response significantly impacted disease acceleration. For OTSCC, it appears that clinical characteristics of the tumour as well as histopathological markers play an important role in the outcome. Efforts towards identifying predictive markers should be continued, especially by sub-site of the oral cavity.

Applicability of preoperative nuclear morphometry to evaluating risk for cervical lymph node metastasis in oral squamous cell carcinoma

BACKGROUND

We previously reported the utility of preoperative nuclear morphometry for evaluating risk for cervical lymph node metastases in tongue squamous cell carcinoma. The risk for lymph node metastasis in oral squamous cell carcinoma, however, is known to differ depending on the anatomical site of the primary tumor, such as the tongue, gingiva, mouth floor, and buccal mucosa. In this study, we evaluated the applicability of this morphometric technique to evaluating the risk for cervical lymph node metastasis in oral squamous cell carcinoma.

METHODS

A digital image system was used to measure the mean nuclear area, mean nuclear perimeter, nuclear circular rate, ratio of nuclear length to width (aspect ratio), and nuclear area coefficient of variation (NACV). Relationships between these parameters and nodal status were evaluated by t-test and logistic regression analysis.

RESULTS

Eighty-eight cases of squamous cell carcinoma (52 of the tongue, 25 of the gingiva, 4 of the buccal mucosa, and 7 of the mouth floor) were included: 46 with positive node classification and 42 with negative node classification. Nuclear area and perimeter were significantly larger in node-positive cases than in node-negative cases; however, there were no significant differences in circular rate, aspect ratio, or NACV. We derived two risk models based on the results of multivariate analysis: Model 1, which identified age and mean nuclear area and Model 2, which identified age and mean nuclear perimeter. It should be noted that primary tumor site was not associated the pN-positive status. There were no significant differences in pathological nodal status by aspect ratio, NACV, or primary tumor site.

CONCLUSION

Our method of preoperative nuclear morphometry may contribute valuable information to evaluations of the risk for lymph node metastasis in oral squamous cell carcinoma.

A simple novel prognostic model for early stage oral tongue cancer

The prognostication of patient outcome is one of the greatest challenges in the management of early stage oral tongue squamous cell carcinoma (OTSCC). This study introduces a simple histopathological model for the prognostication of survival in patients with early OTSCC. A total of 311 cases (from Finland and Brazil) with clinically evaluated early stage OTSCC (cT1-T2cN0cM0) were included in this multicentre retrospective study. Tumour budding (B) and depth of invasion (D) were scored on haematoxylin-eosin-stained cancer slides. The cut-off point for tumour budding was set at 5 buds (low <5; high ≥5) and for depth of invasion at 4mm (low <4mm; high ≥4mm). The scores of B and D were combined into one model: the BD predictive model. On multivariate analysis, a high risk score (BD score 2) correlated significantly with loco-regional recurrence (P=0.033) and death due to OTSCC (P<0.001) in early stage OTSCC. The new BD model is a promising prognostic tool to identify those patients with aggressive cases of early stage OTSCC who might benefit from multimodality treatment.

Clinicopathological prognostic factors of oral tongue squamous cell carcinoma: a retrospective study of 202 cases

Although several histopathological parameters and grading systems have been described as predictive of the treatment response and outcome of oral squamous cell carcinoma (OSCC), none is universally accepted. A new scoring system, the histological risk model, was recently described to be a powerful predictive tool for recurrence and overall survival in OSCC. The aim of this study was to verify the predictive role of the histological risk model in a cohort of 202 patients at all stages of oral/mobile tongue squamous cell carcinoma (OTSCC). Demographic and clinical data were collected from the medical records and the tumours were evaluated using the histological risk model. Statistical analyses were performed using the χ(2) test, the Kaplan-Meier method, and the Cox regression model. The histological risk model showed no statistical correlation with demographic or clinical parameters and did not Predict the outcome of the OTSCC patients. However, multivariate regression analysis revealed a significant correlation of the clinical disease stage with the disease outcome. Despite major efforts to identify new predictive parameters and histological systems, clinical features are still the most reliable prognostic factors for patients with OTSCC.