Tumor budding activity and cell nest size determine patient outcome in oral squamous cell carcinoma: Proposal for an adjusted grading system.

Tumor budding activity and cell nest size determine patient outcome in oral squamous cell carcinoma: Proposal for an adjusted grading system.

Histopathology. 2017 Jan 25;:

Authors: Boxberg M, Jesinghaus M, Dorfner C, Mogler C, Drecoll E, Warth A, Steiger K, Bollwein C, Meyer P, Wolff KD, Kolk A, Weichert W

Abstract
Oral squamous cell carcinoma (OSCC) is a common malignancy with a variable clinical course. One of the established survival predictors in carcinomas in general is tumor grade, in OSCC however, grading according to the WHO has no independent prognostic impact. Recently, a novel grading scheme associated with high impact on patient outcome has been proposed for squamous cell carcinoma of the lung. To probe whether this scheme could be applied to the upper aerodigestive tract, we retrospectively evaluated 157 chemo- and radiotherapy naive OSCCs with complete clinical follow-up data and standardized treatment for tumor budding activity, cell nest size, extent of keratinization, stromal content, nuclear size and mitotic count. Histomorphological characteristics were correlated with clinicopathological data and patient outcome. Like in squamous cell carcinoma of the lung, high budding activity and small cell nest size were significantly correlated with shortened overall, disease-specific and disease-free survival. A three-tiered grading system based on a sum score of these two prognostic markers proved to be a strong age-, stage- and sex-independent prognosticator for survival with a hazard ratio for overall survival of 2.1 for intermediately differentiated (G2) tumors and 3.4 for poorly differentiated (G3) tumors compared to well differentiated (G1) tumors (p<0.001). In conclusion, we almost exactly recapitulated and validated the strong prognostic impact of a grading algorithm recently proposed for squamous cell carcinoma of the lung in OSCC. Our data may pave the way for a prognostically highly relevant future squamous cell carcinoma grading system broadly applicable in the aerodigestive tract. This article is protected by copyright. All rights reserved.

PMID: 28122134 [PubMed - as supplied by publisher]

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