B-cell clusters at the invasive margin associate with longer survival in early-stage oral-tongue cancer patients

Abstract Background The purpose of the study was to evaluate survival outcomes in post-operative oral tongue cancer patients undergoing adjuvant radiotherapy (RT) at a tertiary cancer care center and to critically review the impact of various clinical-pathological factors on recurrence and survival. Demographic factors, stage of all the histology proven oral tongue cancer, and treatment details were documented. Overall survival (OS) and recurrence-free survival (RFS) were analyzed along with the potential prognostic factors affecting outcome. Results One hundred forty-four post-operative oral tongue cancer patients referred to our department for adjuvant treatment were evaluated. Median age at presentation was 45 years. Forty-seven patients had pathological early stage disease (stages I and II) and 95 had locally advanced (stages III and IV) disease while post-op details were not present in 2 patients. At a median follow-up of 87 months (60–124) of alive patients, the median RFS for entire cohort was 62 months while median OS was 74 months respectively. Age, perineural invasion (PNI), and grade of the tumor emerged as independent prognostic factors for OS and RFS. Among patients with early stage disease, depth of invasion (DOI), age, and PNI were found as independent prognostic factors for RFS and OS. In locally advanced disease, higher grade, age, and PNI independently impacted the respective survival end points. Conclusions Age (> 45 years), higher grade, and presence of PNI showed inferior survival outcomes across the sub-groups (early versus locally advanced disease). This may warrant adjuvant treatment intensification. DOI > 10 mm was particularly found to worsen survival in early node negative SCC oral tongue patients.

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Improving Risk Stratification of Early Oral Tongue Cancer with TNM-Immune (TNM-I) Staging System

Cancers ◽

10.3390/cancers13133235 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3235

Author(s):

Alhadi Almangush ◽

Ibrahim O. Bello ◽

Ilkka Heikkinen ◽

Jaana Hagström ◽

Caj Haglund ◽

...

Keyword(s):

Overall Survival ◽

Tongue Cancer ◽

Early Stage ◽

Disease Free Survival ◽

Tumor Infiltrating Lymphocytes ◽

Staging System ◽

Oral Tongue ◽

Oral Tongue Cancer ◽

Important Player ◽

Infiltrating Lymphocytes

Although patients with early-stage oral tongue squamous cell carcinoma (OTSCC) show better survival than those with advanced disease, there is still a number of early-stage cases who will suffer from recurrence, cancer-related mortality and worse overall survival. Incorporation of an immune descriptive factor in the staging system can aid in improving risk assessment of early OTSCC. A total of 290 cases of early-stage OTSCC re-classified according to the American Joint Committee on Cancer (AJCC 8) staging were included in this study. Scores of tumor-infiltrating lymphocytes (TILs) were divided as low or high and incorporated in TNM AJCC 8 to form our proposed TNM-Immune system. Using AJCC 8, there were no significant differences in survival between T1 and T2 tumors (p > 0.05). Our proposed TNM-Immune staging system allowed for significant discrimination in risk between tumors of T1N0M0-Immune vs. T2N0M0-Immune. The latter associated with a worse overall survival with hazard ratio (HR) of 2.87 (95% CI 1.92–4.28; p < 0.001); HR of 2.41 (95% CI 1.26–4.60; p = 0.008) for disease-specific survival; and HR of 1.97 (95% CI 1.13–3.43; p = 0.017) for disease-free survival. The TNM-Immune staging system showed a powerful ability to identify cases with worse survival. The immune response is an important player which can be assessed by evaluating TILs, and it can be implemented in the staging criteria of early OTSCC. TNM-Immune staging forms a step towards a more personalized classification of early OTSCC.

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Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

Radiation Oncology ◽

10.1186/1748-717x-5-43 ◽

2010 ◽

Vol 5 (1) ◽

pp. 43 ◽

Cited By ~ 65

Author(s):

Su Jung Shim ◽

Jihye Cha ◽

Woong Sub Koom ◽

Gwi Eon Kim ◽

Chang Geol Lee ◽

...

Keyword(s):

Cancer Patients ◽

Clinical Outcomes ◽

Tongue Cancer ◽

Postoperative Radiotherapy ◽

Oral Tongue ◽

Oral Tongue Cancer

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Should Depth of Invasion Determine the Need for Postoperative Radiation Therapy in Early-Stage Oral Tongue Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.875 ◽

2018 ◽

Vol 102 (3) ◽

pp. e270

Author(s):

J.M. Mann ◽

D.A. Julie ◽

S. Mahase ◽

D. D'Angelo ◽

A.G. Wernicke ◽

...

Keyword(s):

Radiation Therapy ◽

Tongue Cancer ◽

Early Stage ◽

Depth Of Invasion ◽

Postoperative Radiation ◽

Oral Tongue ◽

Postoperative Radiation Therapy ◽

Oral Tongue Cancer

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Depth of invasion, tumor budding, and worst pattern of invasion: Prognostic indicators in early‐stage oral tongue cancer

Head & Neck ◽

10.1002/hed.23380 ◽

2013 ◽

Vol 36 (6) ◽

pp. 811-818 ◽

Cited By ~ 118

Author(s):

Alhadi Almangush ◽

Ibrahim O. Bello ◽

Harri Keski–Säntti ◽

Laura K. Mäkinen ◽

Joonas H. Kauppila ◽

...

Keyword(s):

Tongue Cancer ◽

Early Stage ◽

Tumor Budding ◽

Prognostic Indicators ◽

Depth Of Invasion ◽

Oral Tongue ◽

Oral Tongue Cancer ◽

Pattern Of Invasion ◽

Worst Pattern Of Invasion

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A novel tumor: Specimen index for assessing adequacy of resection in early stage oral tongue cancer

Oral Oncology ◽

10.1016/j.oraloncology.2013.11.009 ◽

2014 ◽

Vol 50 (3) ◽

pp. 213-220 ◽

Cited By ~ 5

Author(s):

Pablo H. Montero ◽

Frank L. Palmer ◽

Andrew G. Shuman ◽

Purvi D. Patel ◽

Jay O. Boyle ◽

...

Keyword(s):

Tongue Cancer ◽

Early Stage ◽

Oral Tongue ◽

Tumor Specimen ◽

Oral Tongue Cancer

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A simple novel prognostic model for early stage oral tongue cancer

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2014.10.004 ◽

2015 ◽

Vol 44 (2) ◽

pp. 143-150 ◽

Cited By ~ 53

Author(s):

A. Almangush ◽

R.D. Coletta ◽

I.O. Bello ◽

C. Bitu ◽

H. Keski-Säntti ◽

...

Keyword(s):

Prognostic Model ◽

Tongue Cancer ◽

Early Stage ◽

Oral Tongue ◽

Oral Tongue Cancer

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SU-E-T-887: Cyberknife Treatment for Early Stage Oral Tongue Cancer - Feasibility Study

Medical Physics ◽

10.1118/1.3612851 ◽

2011 ◽

Vol 38 (6Part24) ◽

pp. 3695-3696

Author(s):

J Fan ◽

E Fourka ◽

S Hayes ◽

L Jin ◽

L Wang ◽

...

Keyword(s):

Feasibility Study ◽

Tongue Cancer ◽

Early Stage ◽

Oral Tongue ◽

Oral Tongue Cancer

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Controversies in relation to neck management in N0 early oral tongue cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyy196 ◽

2019 ◽

Vol 49 (4) ◽

pp. 297-305 ◽

Cited By ~ 7

Author(s):

Nobuhiro Hanai ◽

Takahiro Asakage ◽

Naomi Kiyota ◽

Akihiro Homma ◽

Ryuichi Hayashi

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Tongue Cancer ◽

Early Stage ◽

Oral Tongue ◽

Invasive Treatment ◽

Node Metastasis ◽

Oral Tongue Cancer ◽

Prophylactic Neck Dissection ◽

Occult Lymph Node Metastasis

Abstract The standard local treatment for early-stage tongue cancer with no clinical lymph node metastases is partial glossectomy. The frequency of occult lymph node metastasis is ~20–30%. Thus, whether prophylactic neck dissection with glossectomy or glossectomy alone should be performed has been a controversial issue since the 1980s. Both treatments have advantages and disadvantages; however, especially in cases involving prophylactic neck dissection, surgical invasion and complications including the cosmetic disadvantage caused by neck skin incision, accessory nerve paralysis or facial nerve (mandibular marginal branch) paralysis, stiffness of the shoulder or neck and a feeling of neck tightness have been considered issues that could be solved by providing less-invasive treatment to the 70–80% of patients without occult lymph node metastasis. A more accurate preoperative diagnosis and strict follow-up are required to provide minimally invasive treatment while ensuring the therapeutic effect. It is also necessary to narrow down the target based on the risk–benefit balance. The depth of invasion should be considered in cases involving oral cavity malignancies. This was also taken into account in recent revisions of eighth edition of the TNM Classification of Malignant Tumors and it is an important factor for N0 neck management. This review article summarizes previous and recent reports on neck management, focusing on the risk–benefit and future perspectives of the diagnosis and treatment of early-stage oral tongue cancer. This effort is an attempt to establish treatment from the patient’s point of view, with the patient’s quality of life taken into account.

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