OBJECTIVE MEASUREMENT OF TUMOR FRONTS IN EARLY ORAL CANCER

Introduction Oral cancer, one of the 10 most common cancers worldwide, has a high mortality rate, and the level of disfigurement that survivors experience gives rise to a considerable global public health burden. Some early-stage oral tongue squamous cell carcinomas (OTSCCs) show aggressive behavior and poor prognosis even in cN0 patients. This motivates the search for prognostically relevant features to tailor individual management. Histopathologic reporting of oral cancer is limited by some elements of subjectivity. This study aimed to identify quantitative histologic features that allow objective stratification of patients into treatment categories and improve overall patient outcome. Methods We conducted a retrospective study of 50 cases of early stage T1/T2 OTSCC. Sections immunostained with anti–pan-cytokeratin antibodies were scanned into digital images to assess the global complexity (fractal dimension) of the tumor epithelial–connective tissue interface (ECTI). The results were related to information from the Royal College of Pathology Dataset for mucosal malignancies of the oral cavity. Results At tumor depths over 5.5 mm, there was a positive correlation between tumor invasion depth and ECTI complexity. There were also significant differences in ECTI complexity between tumors graded as well, moderately, and poorly differentiated (1.24 ± 0.10, 1.32 ± 0.06, and 1.39 ± 0.07, respectively). The ECTI complexity in poorly differentiated tumors was significantly lower in the patients with a positive 5-year survival status. Conclusions Fractal analysis of the ECTI provided an unbiased descriptor of neoplasm dissociation and invasion pattern modality with potentially useful prognostic value.