HISTOPATHOLOGIC, STEREOLOGIC, EPIDEMIOLOGIC, AND CLINICAL-PARAMETERS IN THE PROGNOSTIC EVALUATION OF SQUAMOUS-CELL CARCINOMA OF THE ORAL CAVITY

Background. Prognostic indicators that could assist in a more precise selection of patients with oral cancer for differentiated therapy woul d be clinically valuable. Methods. A consecutive series of 161 cases o f intraoral squamous cell carcinoma (SCC) occurring during a 5-year pe riod in a population of 1.4 million inhabitants, was evaluated by hist opathologic (the modified classification of Jakobsson et al.), stereol ogic, clinical, and epidemiologic parameters and the serum markers hem oglobin and rhesus blood group. Results. Univariate analysis establish ed a significant prognostic value in terms of cause-specific survival for T stage (P < .0001), stage (P < .0001), maximum tumor diameter (P < .0001), N stage (N+/NO) (P < .0001), alcohol consumption (P = .03), stereologic estimates of nuclear volume (P = .04), and the histomorpho logic parameters mode of invasion (P = .001), pattern (P = .01), vascu lar invasion (P = .02), depth (P = .006), and mean histologic score. T obacco consumption was borderline significant (P = .055). A multivaria te analysis using the Cox proportional hazard analysis showed that bot h clinical (stage, P < .0001; size, P = .0027), epidemiologic (tobacco consumption, P = .0054), morphohistopathologic (mode of invasion P < .0001), and stereologic (nuclear volume, P = .0010) parameters had an independent significant effect on survival. Inversely, the mean histol ogic score had no prognostic value. From the final regression model pr ognostic forecasts were calculated. Twelve patients (25%) with stage I disease had unfavorable histologic and stereologic parameters. The ob served survival (ii standard error of the estimate) for these patients was 33% +/- 18%. The observed survival for stage I patients with more favorable histologic and stereologic characteristics (n = 36) was 76% +/- 8%. Conclusion. The use of a combination of clinical, histologic, epidemiologic, and stereologic parameters will assist the design of t reatment strategies for intraoral SCC. (C) 1996 John Wiley & Sons, Inc .