title: Histological differentiation of primary oral squamous cell carcinomas in an area of betel quid chewing prevalence.
abstract: OBJECTIVE
  This study evaluated associations between the histological differentiation of oral squamous cell carcinoma and additional clinicopathological manifestations, adverse events after treatment, and the outcomes of patients in a region prevalent for betel quid chewing.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 150 patients with primary oral squamous cell carcinomas who underwent surgery with or without adjuvant therapy were enrolled.
  
  
  RESULTS
  Well, moderate, and poorly differentiated oral squamous cell carcinomas were reported in 54 (36%), 84 (56%), and 12 (8%) patients, respectively. There were no significant differences among different histological differentiations in age, sex, tumor, node, metastasis stage, bone invasion, depth of invasion, and history of carcinogen exposure. However, we found significant associations between tumor histological differentiation and nodal metastasis (P < 0.0001), extracapsular spread (P = 0.002), and perineural invasion (P < 0.0001). In the analysis of adverse events for survival during patient follow-up, oral squamous cell carcinomas with poor differentiation had a higher probability of developing neck recurrence (P = 0.001) and distant metastasis (P = 0.019), but not local recurrence or a second primary cancer. For survival analysis, univariate analysis showed that patient age, tumor stage, extracapsular spread, presence of perineural invasion, and tumor differentiation were significant factors. Multivariate analysis further demonstrated that poor differentiation (P = 0.007) was still a statistically significant factor.
  
  
  CONCLUSIONS
  The current study demonstrates that poorer tumor histological classifications of oral squamous cell carcinoma are significantly associated with positive nodal status, extracapsular spread, perineural invasion of primary tumors, and the probability of developing neck recurrence and distant metastasis after treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ku-Hao
authors.initials: KH
authors.lastname: Fang
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Cheng
authors.forename: Yu-Liang
authors.initials: YL
authors.lastname: Chang
authors.forename: Ngan-Ming
authors.initials: NM
authors.lastname: Tsang
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Huang
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.forename: Jau-Song
authors.initials: JS
authors.lastname: Yu
authors.forename: Sheng-Po
authors.initials: SP
authors.lastname: Hao
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001114:Areca; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D015995:Prevalence; D018709:Statistics, Nonparametric; D016019:Survival Analysis