A Predictive Model to Determine the Pattern of Nodal Metastasis in Oral Squamous Cell Carcinoma.

BACKGROUND: Developing histological prediction models that estimate the probability of developing metastatic deposit will help clinicians to identify individuals who need either radical or prophylactic neck dissection, which leads to better prognosis. Identification of accurate predictive models in oral cancer is important to overcome extensive prophylactic surgical management for neck nodes. Therefore, accurate prediction of metastasis in oral cancer would have an immediate clinical impact, especially to avoid unnecessary radical treatment of patients who are at a low risk of metastasis. METHODS: Histologically confirmed OSCC cases with neck dissection were used. Interrelation of demographic, clinical, and histological data was done using univariate and multivariate analysis. RESULTS: 465 cases were used and presence of metastasis and extracapsular invasion were statistically well correlated with level of differentiation (p < 0.001) and pattern of invasion (p < 0.001). Multivariate analysis showed level of differentiation, pattern of invasion, and stage as predictors of metastasis. CONCLUSIONS: The proposed predictive model may provide some guidance for maxillofacial surgeons to decide the appropriate treatment plan for OSCC, especially in developing countries. This model appears to be reliable and simple and may guide surgeons in planning surgical management of neck nodes.

VEGF-C is associated with lymphatic status and invasion in oral cancer.

BACKGROUND: Nodal metastasis is a major prognostic indicator for oral squamous cell carcinoma (OSCC) progression. Recently, it has been revealed that lymphangiogenic growth factor VEGF-C and its receptor Flt-4 play an important role for invasion and metastasis in cancer cells. AIM: To examine VEGF-C expression and its correlation with lymphatic status, including the number of lymph vessels and lymphatic invasion, tumour invasion and metastasis in OSCC. METHODS: Intratumoural and peritumoural lymphatic vessels were examined using D2-40 in 54 OSCC cases and correlated with VEGF-C expression and clinicopathological findings. The histological pattern of invasion and pathological findings were compared. RESULTS: High expression of VEGF-C was frequently observed in OSCC and was associated with increased number of lymph vessels and lymphatic invasion. VEGF-C was well correlated with invasion pattern and metastasis. CONCLUSIONS: Results suggest that VEGF-C may play an important role for lymphangiogenesis and invasion in the metastatic process and can be a strong predicting factor for metastasis of OSCC.

Analysis of histopathological and immunohistochemical differences of oral squamous cell carcinoma in young and old patients in Sri Lanka.

BACKGROUND: Oral squamous cell carcinoma (OSCC) most commonly occurs in the middle-aged and older individuals. The purpose of the present study was to evaluate the histopathological and immunohistochemical differences of the younger (<40 years) and the older (more than 50 years) groups. METHODS: The histopathological parameters of 112 patients (younger 56 and older 56) were compared according to three grading systems (Broder JAMA 1920; 74: 656, Anneroth et al. Scand J Dent Res 1987; 95: 229, Bryne et al. J Pathol 1992; 166: 375) and as individual histopathological parameters. Further, the expression of p53 and Proliferative Cell Nuclear Antigen (PCNA) index was also compared. RESULTS: Although there was no significant difference between two groups regarding the three grading systems, a significantly higher number of nuclear aberrations was found in younger group (P<0.001). Interestingly, higher number of mitoses (P<0.05) and lymph node metastasis (P<0.05) were observed in the older group (P<0.05). Furthermore, significantly a higher PCNA index was found in the older group (P<0.005). CONCLUSIONS: Although tumours of the young patients showed more nuclear aberrations, OSCC of the older patients is proliferative and showed higher metastatic rate.