COMPARISON OF HISTOPATHOLOGICAL FEATURES BETWEEN PRIMARY AND RECURRENT ORAL SQUAMOUS CELL CARCINOMAS: IMPLICATIONS FOR MANAGEMENT STRATEGIES

Abstract

Objectives: To assess clinical and histopathological characteristics of primary and recurrent OSCC about the tumor site, grade, stage, lymph node involvement, and tobacco habits, which determine the prognosis and recurrence.
Materials and Methods: Our cross-sectional study recruited 80 consecutive participants i-e 40 patients with primary tumors and 40 patients with secondary/recurrent tumors. The study was conducted in Bacha Khan College of Dentistry in a time of 5 years. The participants were divided into two groups i-e primary tumors (without recurrence) (n=40) and secondary tumors (with recurrence) (n=40). The participant’s age, gender, history of tobacco use, tumor location, management, grade, stage, presence or absence of recurrence, and survival rates were collected from the clinical records and tumor registers. OSCC slides (both primary and recurrent) were collected from the department of pathology Bacha Khan College of Dentistry to confirm the diagnosis of the primary and secondary tumors. The recurrent tumor sites were identifi ed as local, secondary, or distant sites. The recurrence of the tumor was confirmed histologically and was considered in patients with advancement of the disease and had no cure to treatment. The second primary tumors within the site were also considered recurrent tumors. Tumor grading was performed according to the WHO classifications and survival analysis was performed using the Kaplan-Meier and Cox proportional hazards regression to determine effects of these features on overall survival and cancer-specific survival.                                                                                                                                                          Results: The Kaplan-Meier estimator test established differences in survival characteristics of primary and recurrent tumors, with tobacco use significantly present. In this study, a history of tobacco use was associated with a poorer overall survival of patients (p=0.04), as well as cancer-specific survival (p=0.04). However, clinically, tobacco use has been shown not only to be an independent risk factor for OSCC but also a signifi cant factor for tumor recurrence and poor survival, which demands an effective control in smokers. We also noted that primary tumor site inflenced survival: patients with tumor in the buccal mucosa had worst survival rates (p = 0.04). Furthermore, lymphatic infiltration was identified as an independent predictor of poor prognosis and hazardous for both OS and cancer-related survival (p = 0.006). These imply the need for closer follow-up and assertive intervention on patients who exhibit lymphatic spread and particular anatomic site manifestation.
Conclusion: Continued tobacco use, buccal mucosa tumors, and patients with lymphatic infiltration were found to have poor survival rates which indicated that such patients require more intense treatment modalities. These results underscore the need for the inclusion of the factors in the management of care especially on smoking cessation, targeted therapies, and frequent follow-up of patients with unfavorable molecular profiles. However, due to its single-institution design and low number of cases included, the generalization of our findings is restrained; therefore, more extensive investigations should be conducted in the future to validate and further develop our
findings in OSCC prognosis.