Evaluation of Depth of Invasion, Pattern of Invasion, Tumour Thickness and Tumour Budding as Potential Prognostic Factors in Oral Verrucous Carcinoma

Objectives Verrucous carcinoma (VC) is a well-differentiated variant of the squamous cell carcinoma (SCC), characterised by both endophytic and exophytic growth, and a minimal tendency for metastasis. Hybrid verrucous carcinoma (HVC) is a distinct variant of VC that exhibits areas of conventional SCC within the otherwise well-differentiated, exophytic, and slow-growing architecture typical of VC. Despite its distinct clinical and histological features, VC is often under-recognised and under-researched, particularly in comparison to conventional SCC. One of the critical gaps in current literature is the lack of systematic studies evaluating histopathological parameters such as depth of invasion (DOI), pattern of invasion (POI), tumour budding (TB), and tumour thickness (TT), and their correlation with clinical outcomes. To date, no comprehensive studies have addressed these parameters in VC, leaving a significant void in oncologic pathology. Therefore, the present study aims to analyse the pathologic parameters, such as assessment of TT, DOI, POI, and TB, in OVC and HVC, and interpret whether these factors can serve as better prognostic tools in analysing progression. Material and Methods A retrospective study was carried out on tissue sections obtained from archival biopsy specimens of 30 clinically diagnosed and histopathologically confirmed cases of OVC and HVC (that exhibit histopathological features of both conventional SCC and VC cases from the year 2010-2022 in the Institution’s department of Oral and Maxillofacial Pathology and Oral Microbiology. The pathologic features like TT, DOI, POI, and TB were analysed. The patient’s clinical details, including demographic data, habits, and treatment history with survival/expiry data, were also recorded for statistical analysis. For categorical and continuous data, a descriptive analysis was conducted using Kaplan-Meier survival curves. The validity of invasion depth, TT, TB, and invasion pattern as predictive markers was visualised. Results All four histopathological parameters were found to be significant indicators of disease progression in OVC. Among them, TB and POI were statistically significant predictors of prognosis (p < 0.05). A Kaplan-Meier survival analysis was performed, with a follow-up period of 5 years to assess overall and disease-free survival.” Conclusion The pathological parameters studied, such as TB, POI, DOI, and TT, were found to be valuable indicators for predicting the progression of OVC. However, the study is limited by its retrospective nature. The relatively small sample size also limited the statistical power and reliability of Kaplan-Meier survival analysis. Future prospective studies with larger cohorts and extended follow-up are necessary to validate these findings and to explore the prognostic impact of these parameters using survival analysis methods such as Kaplan-Meier curves.