Tumor Vascular Area Quantification Predicts Survival Outcomes in Oral Squamous Cell Carcinoma

Cancer cells remodel blood vessels to create a tumor-supportive environment; however, the spatial distribution of these vessels and their prognostic significance in oral squamous cell carcinoma (OSCC) remain poorly defined.

We established an open-source pipeline to quantify vascular area (VA) in both the inner tumor (InT) and invasive tumor front (ITF) regions from CD31-stained whole-slide images (discovery cohort, n = 66). The associations between VA and patient survival were assessed via univariate and multivariate analyses. Findings were validated in an independent cohort (n = 70) immunostained with CD34.

VA was significantly higher in the InT region compared to the ITF (p = 0.0079). A higher VA in the ITF was independently associated with favorable overall survival (discovery: HR 0.28, 95% CI 0.11-0.73, p = 0.009; validation: HR 0.18, 95% CI 0.07-0.47, p < 0.001) and disease-free survival (discovery: HR 0.34, 95% CI 0.14-0.81, p = 0.015; validation: HR 0.25, 95% CI 0.11-0.53, p < 0.001).

Our findings provide the first evidence that high VA in the ITF is associated with a better prognosis in OSCC.