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Prognostic Implications of Combined Imaging and Histologic Criteria in Squamous Cell Carcinoma With Mandibular Invasion

 Chena Lee  ;  Yoon Joo Choi  ;  Kug Jin Jeon  ;  Dong Wook Kim  ;  Woong Nam  ;  Hyung Jun Kim  ;  In-Ho Cha  ;  Sang Sun Han 
 JOURNAL OF CLINICAL MEDICINE, Vol.9(5) : 1335, 2020-05 
Journal Title
Issue Date
computed tomography ; diagnostic imaging ; magnetic resonance imaging ; oral cancers ; squamous cell carcinoma ; tumor staging
Prognosis prediction of squamous cell carcinoma (SCC) with mandibular invasion is controversial, and a more sophisticated staging system to aid prognosis could be developed with imaging characteristics of bone invasion. Imaging-feature analysis provides practical, stratified results for survival prognosis in oral SCC (OSCC) of the mandible, and imaging advances enable more detailed tumor visualization. We retrospectively evaluated significant bone-invasion features associated with poor outcomes in mandibular OSCC to assess the predictive value of staging criteria that combined imaging features and histologic grade (combined imaging-histology (IH) grade) in 65 patients (39 men, 26 women) with mandibular SCC diagnosed from 2006 to 2016. Clinicopathologic features, including T-stage and histologic grade, and prognosis were retrieved. Tumors were classified into three types by extent of mandibular invasion on pretreatment imaging studies. Moreover, we assessed the involvement of the mandibular canal. We examined the correlation of factors associated with locoregional recurrence and overall mortality. The Harrell Concordance Index (C-index) determined prognostic performance of predictors. Nineteen (29%) patients showed locoregional recurrence and 13 (20%) died. For locoregional recurrence and mortality rates, imaging-detected mandibular canal (MC) involvement is a stronger prognostic factor for recurrence (C-index = 0.61 > 0.58) and survival (C-index = 0.58 > 0.63) than histopathologically confirmed perineural invasion, as was the IH grade, especially IH Grade 3, which was significantly associated with worse locoregional recurrence (p < 0.02). Imaging-based staging showed higher prognostic performance than T-staging (C-index = 0.57 (recurrence), 0.60 (death)), when combined with histologic grading (C-index = 0.69 for both) or used alone (C-index = 0.63 (locoregional recurrence), 0.69 (death)). Overall survival was significantly stratified by Imaging type and IH grade. Therefore, analysis of imaging features provided more specific, practical results for survival prognosis in mandibular OSCC. Imaging advances can potentially provide detailed gross views of tumor masses to facilitate development of prognostic criteria for OSCC.
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2. College of Dentistry (치과대학) > Dept. of Oral and Maxillofacial Surgery (구강악안면외과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Oral and Maxillofacial Radiology (영상치의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱) ORCID logo https://orcid.org/0000-0001-6167-6475
Kim, Hyung Jun(김형준) ORCID logo https://orcid.org/0000-0001-8247-4004
Nam, Woong(남웅) ORCID logo https://orcid.org/0000-0003-0146-3624
Lee, Chena(이채나) ORCID logo https://orcid.org/0000-0002-8943-4192
Jeon, Kug Jin(전국진) ORCID logo https://orcid.org/0000-0002-5862-2975
Cha, In Ho(차인호) ORCID logo https://orcid.org/0000-0001-8259-2190
Choi, Yoon Joo(최윤주) ORCID logo https://orcid.org/0000-0001-9225-3889
Han, Sang Sun(한상선) ORCID logo https://orcid.org/0000-0003-1775-7862
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