Risk Stratification in Oral Cancer: A Novel Approach

Irene Wen-Hui Tu; Nicholas Brian Shannon; Krishnakumar Thankappan; Deepak Balasubramanian; Vijay Pillai; Vivek Shetty; Vidyabhushan Rangappa; Naveen Hedne Chandrasekhar; Vikram Kekatpure; Moni Abraham Kuriakose; Arvind Krishnamurthy; Arun Mitra; Arun Pattatheyil; Prateek Jain; Subramania Iyer; Narayana Subramaniam; N Gopalakrishna Iyer

doi:10.3389/fonc.2022.836803

Risk Stratification in Oral Cancer: A Novel Approach

Front Oncol. 2022 Jul 7:12:836803. doi: 10.3389/fonc.2022.836803. eCollection 2022.

Authors

Irene Wen-Hui Tu¹, Nicholas Brian Shannon¹, Krishnakumar Thankappan², Deepak Balasubramanian², Vijay Pillai³, Vivek Shetty³, Vidyabhushan Rangappa³, Naveen Hedne Chandrasekhar³, Vikram Kekatpure³, Moni Abraham Kuriakose³, Arvind Krishnamurthy⁴, Arun Mitra⁴, Arun Pattatheyil⁵, Prateek Jain⁵, Subramania Iyer², Narayana Subramaniam³, N Gopalakrishna Iyer¹

Affiliations

¹ Department of Head and Neck Surgery Singapore General Hospital and National Cancer Centre Singapore and Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.
² Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India.
³ Department of Head and Neck Surgical Oncology, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, India.
⁴ Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India.
⁵ Department of Head and Neck Surgical Oncology, Tata Medical Centre, Kolkata, India.

Abstract

Background: Oral squamous cell carcinoma (OSCC) is a common head and neck cancer with high morbidity and mortality. Currently, treatment decisions are guided by TNM staging, which omits important negative prognosticators such as lymphovascular invasion, perineural invasion (PNI), and histologic differentiation. We proposed nomogram models based on adverse pathological features to identify candidates suitable for treatment escalation within each risk group according to the National Comprehensive Cancer Network (NCCN) guidelines.

Methods: Anonymized clinicopathologic data of OSCC patients from 5 tertiary healthcare institutions in Asia were divided into 3 risk groups according to the NCCN guidelines. Within each risk group, nomograms were built to predict overall survival based on histologic differentiation, histologic margin involvement, depth of invasion (DOI), extranodal extension, PNI, lymphovascular, and bone invasion. Nomograms were internally validated with precision-recall analysis and the Kaplan-Meier survival analysis.

Results: Low-risk patients with positive pathological nodal involvement and/or positive PNI should be considered for adjuvant radiotherapy. Intermediate-risk patients with gross bone invasion may benefit from concurrent chemotherapy. High-risk patients with positive margins, high DOI, and a high composite score of histologic differentiation, PNI, and the American Joint Committee on Cancer (AJCC) 8th edition T staging should be considered for treatment escalation to experimental therapies in clinical trials.

Conclusion: Nomograms built based on prognostic adverse pathological features can be used within each NCCN risk group to fine-tune treatment decisions for OSCC patients.

Keywords: cancer staging; head and neck tumors; nomogram; oral squamous cell carcinoma (OSCC); overall survival; pathological prognostic indicators; treatment escalation plan.