Proposed classification system for oral squamous cell carcinoma - "integrated histologic-molecular scoring system"...

Area of Science:

• Oncology
• Pathology
• Molecular Biology

Background:

• Oral squamous cell carcinoma (OSCC) exhibits significant biological heterogeneity.
• Current histopathological grading systems for OSCC, based on differentiation and keratinization, have limited predictive value.
• Independent predictors like invasion patterns and molecular biomarkers are crucial for OSCC prognosis.

Purpose of the Study:

• To develop and introduce an integrated histologic-molecular scoring system (IHMSS) for OSCC.
• To enhance the prognostic accuracy of OSCC grading by combining histopathological and molecular features.
• To provide a more precise risk stratification for OSCC patients.

Main Methods:

• The IHMSS integrates histopathological parameters (differentiation, invasion depth/pattern, lymphovascular/perineural invasion, tumor budding) with molecular/immunohistochemical markers.
• Each parameter is assigned a weighted score based on biological relevance and literature evidence.
• Cumulative scores stratify tumors into distinct risk categories for routine FFPE tissue sections.

Main Results:

• The study classified 33.3% of OSCC cases as low risk and 50% as intermediate risk.
• Tumor budding, invasion pattern, and cancer-associated fibroblast density were key score contributors.
• Well-differentiated tumors showed variable risk stratification, underscoring the value of composite scoring.

Conclusions:

• The IHMSS offers a novel, multidimensional approach integrating histopathology and molecular oncology for OSCC.
• This system addresses limitations of current grading schemes, aligning with precision oncology principles.
• Further validation in large-scale, multicentric studies is needed to establish the prognostic and predictive utility of the IHMSS.