Advertisement

Prognostic significance of dysplasia associated with oral squamous cell carcinoma in patients undergoing surgery with curative intent

Published:October 03, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.09.008

      Abstract

      The aim of this study was to evaluate the prognostic significance of dysplasia in patients undergoing primary surgery with curative intent in the treatment of oral squamous cell carcinoma (OSCC). This study specifically aimed to demonstrate the effect of dysplasia on local recurrence, disease specific survival (DSS) and overall survival (OS). Data collection for 833 patients with OSCC undergoing treatment for curative intent was undertaken retrospectively for the period of February 2006 to May 2020. Analysis of any association between known clinicopathological prognostic categorical variables with respect to dysplasia was undertaken using the chi squared test. A Kaplan-Meier analysis was performed to demonstrate the impact of dysplasia on DSS and OS, and Cox’s proportional-hazards model deployed to obtain hazard ratios associated with dysplasia and the outcomes of interest. Dysplasia was statistically significant in predicting disease specific and overall survival in patients undergoing primary surgery for OSCC (DSS p<0.001, HR 0.577; 95%CI 0.428 to 0.777), OS p<0.001 HR 0.691; 95%CI 0.562 to 0.850) with the absence of dysplasia predicting poorer outcomes. The absence of dysplasia correlated with pathological higher T and N stage, increased categorised depth of tumour invasion, non-cohesive invasive front, lymphovascular invasion, perineural invasion, extranodal extension and increased modified Glasgow Prognostic Score. No significant prognostic relationship was attributable to the presence of dysplasia at a surgical margin. The absence of dysplasia appeared to be a significant independent prognostic indicator for patients with OSCC. The presence or absence of dysplasia may provide a heuristic means of stratifying OSCC primary lesions in terms of disease hostility.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jack H.
        • Lee K.
        • Polonowita A.
        Dilemmas in managing oral dysplasia: a case report and literature review.
        N Z Med J. 2009; 122: 89-98
        • Warnakulasuriya S.
        Causes of oral cancer – an appraisal of controversies.
        Br Dent J. 2009; 207: 471-475
        • Liu S.A.
        • Wang C.C.
        • Jiang R.S.
        • et al.
        Pathological features and their prognostic impacts on oral cavity cancer patients among different subsites – a single Institute’s experience in Taiwan.
        Sci Rep. 2017; 7: 7451
        • Woolgar J.A.
        • Scott J.
        • Vaughan E.D.
        • et al.
        Survival, metastasis and recurrence of oral cancer in relation to pathological features.
        Ann R Coll Surg Engl. 1995; 77: 325-331
        • Jones K.R.
        • Lodge-Rigal R.D.
        • Reddick R.L.
        • et al.
        Prognostic factors in the recurrence of stage I and II squamous cell cancer of the oral cavity.
        Arch Otolaryngol Head Neck Surg. 1992; 118: 483-485
        • Parsons I.T.
        • Mendenhall W.M.
        • Stringer S.P.
        • et al.
        An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity.
        Int J Radiat Oncol Biol Phys. 1997; 39: 137-148
        • Jones A.S.
        Prognosis in mouth cancer: tumour factors.
        Eur J Cancer B Oral Oncol. 1994; 30B: 8-15
        • Kurita H.
        • Nakanishi Y.
        • Nishizawa R.
        • et al.
        Impact of different surgical margin conditions on local recurrence of oral squamous cell carcinoma.
        Oral Oncol. 2010; 46: 814-887
        • Loree T.R.
        • Strong E.W.
        Significance of positive margins in oral cavity squamous carcinoma.
        Am J Surg. 1990; 160: 410-444
        • Gokavarapu S.
        • Parvataneni N.
        • Pavagada S.
        • et al.
        Mild to moderate dysplasia at surgical margin is a significant indicator of survival in patients with oral cancer.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 123: 330-337
        • Sopka D.M.
        • Li T.
        • Lango M.N.
        • et al.
        Dysplasia at the margin? Investigating the case for subsequent therapy in ‘Low-Risk’ squamous cell carcinoma of the oral tongue.
        Oral Oncol. 2013; 49: 1083-1087
        • Weijers M.
        • Snow G.B.
        • Bezemer P.D.
        • et al.
        The clinical relevance of epithelial dysplasia in the surgical margins of tongue and floor of mouth squamous cell carcinoma: an analysis of 37 patients.
        J Oral Pathol Med. 2002; 31: 11-15
        • Chen T.C.
        • Chang H.L.
        • Yang T.L.
        • et al.
        Impact of dysplastic surgical margins for patients with oral squamous cell carcinoma.
        Oral Oncol. 2019; 97: 1-6
        • Singh A.
        • Mair M.
        • Singhvi H.
        • et al.
        Incidence and impact of dysplasia at final resection margins in cancers of the oral cavity.
        Acta Otolaryngol. 2020; 140: 963-969
        • McMahon J.
        • Devine J.C.
        • McCaul J.A.
        • et al.
        Use of Lugol’s iodine in the resection of oral and oropharyngeal squamous cell carcinoma.
        Br J Oral Maxillofacial Surg. 2010; 48: 84-87
        • Mori M.
        • Adachi Y.
        • Matsushima T.
        • et al.
        Lugol staining pattern and histology of esophageal lesions.
        Am J Gastroenterol. 1993; 88: 701-705