title: Depth of invasion, tumor budding, and worst pattern of invasion: prognostic indicators in early-stage oral tongue cancer.
abstract: BACKGROUND
  Oral (mobile) tongue squamous cell carcinoma (SCC) is characterized by a highly variable prognosis in early-stage disease (T1/T2 N0M0). The ability to classify early oral tongue SCCs into low-risk and high-risk categories would represent a major advancement in their management.
  
  
  METHODS
  Depth of invasion, tumor budding, histologic risk-assessment score (HRS), and cancer-associated fibroblast (CAF) density were studied in 233 cases of T1/T2 N0M0 oral tongue SCC managed in 5 university hospitals in Finland.
  
  
  RESULTS
  Tumor budding (≥5 clusters at the invasive front of the tumor) and depth of invasion (≥4 mm) were associated with poor prognosis in patients with early oral tongue SCC (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.17-3.55; HR, 2.55; 95% CI, 1.25-5.20, respectively) after multivariate analysis. The HRS and CAF density did not predict survival. However, high-risk worst pattern of invasion (WPOI), a component of HRS, was also an independent prognostic factor (HR, 4.47; 95% CI, 1.59-12.51).
  
  
  CONCLUSIONS
  Analyzing the depth of invasion, tumor budding, and/or WPOI in prognostication and treatment planning of T1/T2 N0M0 oral tongue SCC is recommended.
authors.affiliation: Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland.
authors.forename: Alhadi
authors.initials: A
authors.lastname: Almangush
authors.forename: Ibrahim O
authors.initials: IO
authors.lastname: Bello
authors.forename: Harri
authors.initials: H
authors.lastname: Keski-Säntti
authors.forename: Laura K
authors.initials: LK
authors.lastname: Mäkinen
authors.forename: Joonas H
authors.initials: JH
authors.lastname: Kauppila
authors.forename: Matti
authors.initials: M
authors.lastname: Pukkila
authors.forename: Jaana
authors.initials: J
authors.lastname: Hagström
authors.forename: Jussi
authors.initials: J
authors.lastname: Laranne
authors.forename: Satu
authors.initials: S
authors.lastname: Tommola
authors.forename: Outi
authors.initials: O
authors.lastname: Nieminen
authors.forename: Ylermi
authors.initials: Y
authors.lastname: Soini
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Kosma
authors.forename: Petri
authors.initials: P
authors.lastname: Koivunen
authors.forename: Reidar
authors.initials: R
authors.lastname: Grénman
authors.forename: Ilmo
authors.initials: I
authors.lastname: Leivo
authors.forename: Tuula
authors.initials: T
authors.lastname: Salo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology*; D002648:Child; D042241:Early Diagnosis; D005387:Finland; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014062:Tongue Neoplasms / Q000401:mortality* / Q000473:pathology*
keywords: cancer-associated fibroblast; depth of invasion; disease-specific mortality; histologic risk score; oral tongue squamous cell carcinoma; prognosis; tumor budding; worst pattern of invasion