Comparative analysis of three histologic grading methods for squamous cell carcinoma of the lip.
OBJECTIVE
The aim of this study was to evaluate three histologic grading methods for squamous cell carcinoma (SCC) of the lip, the conventional three-grade model proposed by the World Health Organization, tumor budding and depth of invasion (BD) model, and histologic risk assessment (HRA) model, and to correlate them with prognosis.


METHODS
Fifty-three patients with lip SCC were evaluated.


RESULTS
The mean age was 65 years, 69.8% of the participants were men, and 66.0% of the patients had early-stage tumors. Using the BD and conventional three-grade methods, 52.8% and 64.2% of the cases were graded as low risk, respectively. The HRA model graded 54.7% of the cases as medium risk. In the BD model, the higher histologic grade was associated with worse prognosis (P = 0.045). Overall survival at 5 years was 87.8%. Tumor size (T3 + T4) and lymph node involvement (N+) were associated with reduced overall survival and recurrence-free survival (RFS) (P = 0.002 and 0.005; 0.007 and 0.01, respectively). Surgical treatment combined with radiotherapy was associated with lower RFS (P = 0.03).


CONCLUSIONS
High-grade lip SCC in advanced stages is associated with a poor prognosis. The BD model is a simple and effective tool for the prognostic evaluation of lip SCC.
Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, UNESP - Univ. Estadual Paulista, São José dos Campos, Brazil.
L
L
Strieder
International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil.
C M
http://orcid.org/0000-0001-9016-2668
CM
Coutinho-Camillo
Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, UNESP - Univ. Estadual Paulista, São José dos Campos, Brazil.
V
V
Costa
Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil.
D E
DE
da Cruz Perez
Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.
L P
LP
Kowalski
Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, UNESP - Univ. Estadual Paulista, São José dos Campos, Brazil.
E
E
Kaminagakura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D008046:Lip / Q000473:pathology; D008048:Lip Neoplasms / Q000145:classification / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies
histologic grade; lip squamous cell carcinoma; prognosis; survival analysis