title: Tumour budding evaluated in biopsy specimens is a useful predictor of prognosis in patients with cN0 early stage oral squamous cell carcinoma.
abstract: OBJECTIVE
  Oral squamous cell carcinoma (OSCC) prognosis depends upon lymph node metastasis (LNM). We have reported recently that tumour budding is a good predictive factor for LNM in squamous cell carcinoma (SCC) of the tongue and floor of the mouth (FOM). Our aim was to evaluate whether tumour budding is a good prognostic factor in OSCC.
  
  
  RESULTS
  We examined conventional histopathological assessment and a new factor, tumour budding, in 209 cases of OSCC in incisional biopsy specimens. The relationship of tumour budding with LNM and prognosis was studied. The budding score was evaluated using immunostaining for pan-cytokeratin in all biopsies specimens; the number of budding foci was counted using a ×20 objective lens. Significant factors using univariate analysis (P < 0.05) in association with LNM were the budding score (intermediate or high score ≥3; high score ≥5), tumour grade (2 and 3), tumour depth (≥5 mm), infiltrative pattern (INF), lymphatic invasion and vessel invasion. In multivariate analysis, the budding score, INF and lymphatic invasion were found to be independent risk factors for LNM; in particular, budding score concerning relapse-free survival was statistically significant among patients with T1/2 stage and cN0 cancer using the Kaplan-Meier method and the log-rank test.
  
  
  CONCLUSIONS
  The assessment of tumour budding is effective in predicting prognosis in cN0 early stage OSCC. In T1/2 stage and cN0 cancer, prophylactic neck dissection to prevent LNM should be considered when the tumour budding score regarding pre-operative biopsy specimens is intermediate or high.
authors.affiliation: Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.|Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Seki
authors.affiliation: Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Sano
authors.affiliation: Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokoo
authors.affiliation: Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Tetsunari
authors.initials: T
authors.lastname: Oyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D055815:Young Adult
keywords: lymph node metastasis; oral; squamous cell carcinoma; tumour budding; tumour depth