Predictors of Prognosis for Squamous Cell Carcinoma of Oral Tongue SHIVAKUMAR THIAGARAJAN, MS, DNB, 1 SUDHIR NAIR, MS, MCh, 1 * DEEPA NAIR, MS, DNB, 1 PANKAJ CHATURVEDI, MS, 1 SHUBHADRA V. KANE, MD, 2 JAI PRAKASH AGARWAL, MD, DMRT, 3 AND ANIL K. D’CRUZ, MS, DNB 1 1 Head and Neck Services, Tata Memorial Hospital, Mumbai, India 2 Department of Pathology, Tata Memorial Hospital, Mumbai, India 3 Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India Background and Objectives: Certain tumor‐related factors like thickness increases the risk of nodal metastasis and may affect survival in patients with oral tongue cancers. The objective of this study is to identify those tumor‐related prognostic predictors that can potentially influence decision for adjuvant radiotherapy. Methods: A retrospective review of all patients with oral tongue cancers treated primarily by surgery at Tata Memorial Hospital between January 2007 and June 2010. The demographic and commonly reported histopathological features were analyzed for their influence on disease free and overall survival. Results: Five hundred eighty‐six patients were eligible for the study, of which 416 were males and 117 were females. Follow‐up details were available for 498 (85%) patients with a median follow‐up of 18 months and mean follow‐up of 22 months. There were 302 patients who were alive and disease free at the last follow‐up. This group had a mean follow‐up of 27 months and median follow‐up of 27.5 months. Disease recurrences during follow‐up were observed in 184 (31%) patients. Sixty‐one patients died subsequently. Perineural invasion significantly affected disease free survival (DFS). A tumor thickness of more than 11 mm significantly affected the overall survival (OS). Conclusion: Other than nodal metastasis, tumor‐related factors like thickness and perineural invasion are adverse prognostic factors and can influence survival. These patients, especially in case of early stage cancers, may potentially benefit from postoperative adjuvant radiotherapy. Level of Evidence: 2b. J. Surg. Oncol. 2014;109:639–644. ß 2014 Wiley Periodicals, Inc. KEY WORDS: tongue squamous cell carcinoma; tumor thickness, survival, nodal metastasis INTRODUCTION Several factors affect survival in squamous cell carcinoma of the oral tongue. The nodal metastasis represents the single most important prognostic factor [1] and survival falls below 40% [2] in its presence. Nodal metastasis is higher in patients with larger (higher T stage) and thicker tumors as well as those with adverse histological features like perineural invasion and poor differentiation [3]. Tumors thicker than 4 mm have a significantly higher risk of nodal metastasis compared to thinner ones [4]. The clinical significance of tumor‐related factors like thickness and perineural invasion have not been defined properly. Even though a few studies have also shown that tumor thickness affects survival in oral tongue cancers, a lot of them are small case series spanning over more than 10 years [5]. While the surgery for the primary and the neck nodes has remained the same throughout the last decade, there has been a considerable change in the indication and type of postoperative adjuvant treatment. Postoperative adjuvant radiotherapy is offered for patients with nodal metastasis or with large tumors. With the evidence emerging from the randomized control trials on the use of postoperative chemo‐ radiotherapy in head and neck cancers [6,7], most centers administer postoperative concurrent chemo‐radiotherapy for head and neck cancers patients with adverse factors like extra capsular spead (ECS) and microscopically positive margins. Bernier et al. [7] also included the perineural invasion (PNI) and lymphovascular emboli (LVE) as adverse histological factors and showed benefit from postoperative adjuvant chemo‐radiotherapy. Hence, an analysis of factors influencing survival in patients receiving current evidence based management may identify those adverse prognostic factors that need further attention. The present study had a larger cohort of patients with squamous cancers limited to a single subsite (oral tongue) of the oral cavity and treated in a single institution over a shorter span of time. Patients and Methods The electronic medical records of patients with pathologically proved squamous cell carcinoma of the tongue operated at Tata Memorial Hospital, a tertiary cancer center, between January 2007 and June 2010 were screened for the study. Cases were selected based on the following eligibility criteria: treatment na € |ve, surgery as the first‐line treatment and carcinoma of the oral tongue being the index lesion. We excluded those patients who had epicenter of disease in the base of tongue, those who were treated initially outside TMH, those who received chemotherapy as Abbreviations: ECS, extra capsular spread; LVE, lymphovascular emboli; DFS, disease free survival; OS, overall survival; PMMC, pectoralis major myocutaneous flap; MND, modified neck dissection; PORT, postoperative radiotherapy; CCRT, concurrent chemo radiotherapy; SEER, surveillance, epidemiology and end results; HR, hazard ratio; HNSCC, head and neck squamous cell carcinoma. All authors are full time employees of Tata Memorial Hospital and received no special financial support for this study. *Correspondence to: Sudhir Nair, MS, MCh, Head and Neck Services, Tata Memorial Hospital, Parel, Mumbai, India 400012. Fax: þ91‐22‐24146937. E‐mail: sudhirvr@gmail.com Received 24 August 2013; Accepted 12 January 2014 DOI 10.1002/jso.23583 Published online 12 March 2014 in Wiley Online Library (wileyonlinelibrary.com). Journal of Surgical Oncology 2014;109:639–644 ß 2014 Wiley Periodicals, Inc.