Scoring the future under microscope: Predicting early-stage oral squamous cell carcinoma recurrence with histological markers

Introduction: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer globally. Despite advances in therapeutic modalities, improvements in mortality and morbidity remain limited in early-stage OSCC. This variability in prognosis is due to the tumors biological heterogeneity and challenges in accurately predicting loco-regional recurrence (LRR). Objectives: The objective of the study is to evaluate the influence of the parameters that are included in Brandwein-Gensler (BG) risk model, i.e., lymphovascular invasion (LVI), lymph node metastasis, and depth of invasion (DOI) in predicting LRR in early-stage cases. Materials and Methods: A retrospective analysis was conducted on patients diagnosed with early-stage (T1/T2) OSCC over a 5-year duration who underwent primary surgical resection and had complete follow-up data available. Histopathological parameters were assessed using hematoxylin and eosin-stained sections, and BG risk score was applied based on standard criteria. Statistical analysis: Statistical analysis was done using Chi-square test and Fisher exact test where count is less than 5. Software used to conduct statistical analysis were MS Excel, and SPSS version 26, and P < 0.05 was considered to indicate statistical significance. Results: A total of 101 cases were included in this study, out of which 34 cases (33.67%) showed recurrence. Among evaluated parameters, LVI ( P = 0.004), perineural invasion (PNI) ( P < 0.001), worst pattern of invasion (WPOI) ( P < 0.001), DOI ( P < 0.001), lymphocytic host response (LHR) ( P < 0.001), and risk score ( P < 0.001) were found to be statistically significant predictors of LRR. Conclusions: The integration of histopathological factors such as LVI, PNI, WPOI, and LHR, particularly when evaluated using BG risk model, offers a valuable framework for identifying high-risk patients. Routine incorporation of this scoring system into initial diagnostic assessment can enhance prognostication and inform the selection of candidates for post-surgical adjuvant therapy, ultimately improving patient management and outcomes in early-stage OSCC.