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Published on: April 22, 2019
Proposed modified Brandwein-Gensler histological risk assessment score as prognosticator in oral squamous cell
1Department of Oral Pathology and Microbiology, Christian Dental College and Hospital, Ludhiana, Punjab. India deepti_dentist@yahoo.co.in.
Background:
Histopathological parameters significantly impact the prognosis and treatment strategies of oral squamous cell carcinoma (OSCC). Various risk assessment scores and grading systems have been proposed in the past, primarily based on subjective assessment of microscopic features. To modify Brandwein-Gensler risk score by including the worst pattern of invasion-5, perineural invasion and percentage stromal tumor infiltrating lymphocytes(TILs) and evaluate the relationship of the modified score with clinicopathological variables.
Material And Methods:
This retrospective observational study was conducted on 58 OSCC patients. The density of stromal TILs was determined on routine microscopic sections using image analysis software, thereby quantifying lymphocytic host response as percentage stromal lymphocytes. Furthermore, the modified Brandwein-Gensler risk score was derived from the assessment of the worst pattern of invasion-5, perineural invasion and percentage stromal tumor infiltrating lymphocytes. Chi-square test and Univariate analysis were used to find the association of categorical and continuous variables. The Kaplan-Meier and log-rank tests were used to estimate the survival rates.
Results:
A significant positive association of modified Brandwein-Gensler score was observed with pathological node (p=0.005), tumor grading (p=0.025), depth of invasion(p=0.016) and overall survival (p=0.03), signifying that high score tumors showed poor differentiation, invasive features and lower survival time.
Conclusions:
A modified, simplified and objective version of Brandwein Gensler histological risk assessment score is derived, revealing a significant association with tumor differentiation, depth of invasion and lymph node involvement.
