Histologic and systemic prognosticators for local control and survival in margin-negative transoral laser microsurgery treated oral cavity squamous cell carcinoma
Parul Sinha MBBS, MS
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorMitra Mehrad MD
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorRebecca D. Chernock MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorJames S. Lewis Jr MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorSamir K. El-Mofty DMD, PhD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorNingying Wu PhD
Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorBrian Nussenbaum MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorCorresponding Author
Bruce H. Haughey MBChB, MS, FRACS
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Corresponding author: B. H. Haughey, Department of Otolaryngology Head and Neck Surgery, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO 63110. E-mail: [email protected]Search for more papers by this authorParul Sinha MBBS, MS
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorMitra Mehrad MD
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorRebecca D. Chernock MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorJames S. Lewis Jr MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorSamir K. El-Mofty DMD, PhD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorNingying Wu PhD
Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorBrian Nussenbaum MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorCorresponding Author
Bruce H. Haughey MBChB, MS, FRACS
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
Corresponding author: B. H. Haughey, Department of Otolaryngology Head and Neck Surgery, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO 63110. E-mail: [email protected]Search for more papers by this authorThis work was presented at the American Head and Neck Society annual meeting, Orlando, Florida, April 10, 2013.
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.
Conclusion
“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. © 2014 Wiley Periodicals, Inc. Head Neck 37: 52–63, 2015
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