title: Histologic and systemic prognosticators for local control and survival in margin-negative transoral laser microsurgery treated oral cavity squamous cell carcinoma.
abstract: BACKGROUND
  Appreciable local recurrence rates observed in patients with margin-negative, transoral laser microsurgery (TLM)-treated oral cavity squamous cell carcinoma (SCC) necessitate identification of new prognosticators for local control and survival. A histopathologic index (Brandwein-Gensler score [BGS]) and intrinsic/iatrogenic/chronic conditions causing immune compromise are investigated.
  
  
  METHODS
  From a prospectively assembled database of TLM-treated oral cavity SCC, specimens for 60 patients with a minimum of 2-years follow-up could undergo BGS assignment. Local control, disease-specific survival (DSS), and overall survival (OS) were study endpoints.
  
  
  RESULTS
  "Low-BGS" was recorded in 28 patients (47%) and "high-BGS" in 32 patients (53%), whereas immune compromise was observed in 18%. In multivariate analyses, immune compromise was the only predictor for local control. T classification and immune compromise were prognostic for DSS and OS. "High-BGS" was prognostic only for OS.
  
  
  CONCLUSIONS
  "High-BGS" was associated with recurrences but immune compromise was the most significant predictor of local control and survival in margin-negative, TLM-treated oral cavity SCC. Strategies that maintain/restore tumor-specific immune responses in immune compromised oral cavity SCC hosts need to be developed.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Parul
authors.initials: P
authors.lastname: Sinha
authors.forename: Mitra
authors.initials: M
authors.lastname: Mehrad
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Chernock
authors.forename: James S
authors.initials: JS
authors.lastname: Lewis
authors.forename: Samir K
authors.initials: SK
authors.lastname: El-Mofty
authors.forename: Ningying
authors.initials: N
authors.lastname: Wu
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brandwein-Gensler score risk model; immune compromise; local control; oral carcinoma; transoral laser microsurgery (TLM)