Histological differentiation of primary oral squamous cell carcinomas in an area of betel quid chewing prevalence.
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.
Fang
Ku-Hao
KH
Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Kao
Huang-Kai
HK
Cheng
Ming-Hui
MH
Chang
Yu-Liang
YL
Tsang
Ngan-Ming
NM
Huang
Yu-Chen
YC
Lee
Li-Yu
LY
Yu
Jau-Song
JS
Hao
Sheng-Po
SP
Chang
Kai-Ping
KP
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