Clinical Paper Head and Neck Oncology A simple novel prognostic model for early stage oral tongue cancer A. Almangush, R.D. Coletta, I.O. Bello, C. Bitu, H. Keski-Sa¨ntti, L.K. Ma¨kinen, J.H. Kauppila, M. Pukkila, J. Hagstro¨m, J. Laranne, S. Tommola, Y. Soini, V.-M. Kosma, P. Koivunen, L.P. Kowalski, P. Nieminen, R. Gre´nman, I. Leivo, T. Salo: A simple novel prognostic model for early stage oral tongue cancer. Int. J. Oral Maxillofac. Surg. 2015; 44: 143–150. # 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. A. Almangush a,b , R. D. Coletta c , I. O. Bello a,d , C. Bitu e , H. Keski-Sa¨ ntti f , L. K. Ma¨ kinen f , J. H. Kauppila g , M. Pukkila h , J. Hagstro¨m a,i , J. Laranne j , S. Tommola k , Y. Soini l , V.-M. Kosma l , P. Koivunen m , L. P. Kowalski n , P. Nieminen o , R. Gre´ nman p , I. Leivo a,s , T. Salo e,q,r a Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland; b Institute of Dentistry, University of Misurata, Misurata, Libya; c Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, Sa˜o Paulo, Brazil; d Department of Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, Saudi Arabia; e Department of Diagnostics and Oral Medicine, Institute of Dentistry, University of Oulu, Oulu, Finland; f Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland; g Departments of Surgery and Pathology, University of Oulu and Oulu University Hospital, Oulu, Finland; h Department of Otorhinolaryngology and Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland; i Department of Oral Pathology, Institute of Dentistry, University of Helsinki, Helsinki, Finland; j Department of Otorhinolaryngology and Head and Neck Surgery, Tampere University Hospital, Tampere, Finland; k Department of Pathology, Tampere University Hospital, Tampere, Finland; l Department of Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland; m Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Central Hospital, Oulu, Finland; n Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Centre, Sa˜o Paulo SP, Brazil; o Department of Medical Informatics and Statistics, University of Oulu, Oulu, Finland; p Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland; q Department of Diagnostics and Oral Medicine, Oulu University Hospital and Medical Research Centre, Oulu, Finland; r Institute of Dentistry, University of Helsinki, Helsinki, Finland; s Department of Pathology, University of Turku, Turku, Finland Abstract. The prognostication of patient outcome is one of the greatest challenges in the management of early stage oral tongue squamous cell carcinoma (OTSCC). This study introduces a simple histopathological model for the prognostication of survival in patients with early OTSCC. A total of 311 cases (from Finland and Brazil) with clinically evaluated early stage OTSCC (cT1–T2cN0cM0) were included in this multicentre retrospective study. Tumour budding (B) and depth of invasion (D) were scored on haematoxylin–eosin-stained cancer slides. The cut-off point for tumour budding was set at 5 buds (low <5; high 5) and for depth of invasion at 4 mm (low <4 mm; high 4 mm). The scores of B and D were combined into one model: the BD predictive model. On multivariate analysis, a high risk score (BD score 2) correlated significantly with loco-regional recurrence (P = 0.033) and death due to OTSCC (P < 0.001) in early stage OTSCC. The new BD model is a promising prognostic tool to identify those patients with aggressive cases of early stage OTSCC who might benefit from multimodality treatment. Key words: oral tongue squamous cell carci- noma; prognosis; BD model; tumour budding; depth of invasion. Accepted for publication 6 October 2014 Available online 11 November 2014 Int. J. Oral Maxillofac. Surg. 2015; 44: 143–150 http://dx.doi.org/10.1016/j.ijom.2014.10.004, available online at http://www.sciencedirect.com 0901-5027/020143 + 08 # 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.