Histologic and systemic prognosticators for local control and survival in margin‐negative transoral laser microsurgery treated oral cavity squamous cell carcinoma. Issue 1 (16th January 2014) - Sinha, Parul
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 Neck37: 52–63, 2015