Tumor budding predicts lymph node metastasis in squamous cell carcinoma of the lip

Squamous cell carcinoma of the lip (LSCC) is a relatively rare malignancy. The criteria for performing a neck dissection remain unclear, as reliable predictors for lymph node metastasis (LNM) have not been fully established. This study aimed to identify risk factors for LNM to guide the indication for elective neck dissection.

A total of 57 patients with LSCC were evaluated based on 81 clinical and pathological parameters, including three previously published pathological grading systems. Statistical analyses focused on identifying the most relevant and independent predictors of LNM using univariate and multivariate logistic regression, supplemented by the LASSO algorithm for feature selection.

Tumor size (OR 1.008, p = 0.85) and peritumoral tumor budding (OR 1.43, p = 0.059) emerged as the most relevant independent predictors of LNM. Notably, the number of peritumoral tumor buds was significantly higher in lymph node-positive (pN +) patients compared to lymph node-negative (pN -) patients (p < 0.01). Receiver operating characteristic (ROC) curve analysis demonstrated that peritumoral tumor budding outperformed other classification systems, with the highest area under the curve (AUC = 0.86).

Peritumoral tumor budding shows strong predictive potential for lymph node metastasis in LSCC, offering valuable insights for the preoperative evaluation and indication for elective neck dissection.