The predictive and prognostic value of tumor-stromal ratio and tumor budding in the recurrence and outcome of patients with oral tongue squamous cell carcinoma.

Introduction: This study aimed to explore the predictive and prognostic value of tumor-stromal ratio (TSR) and tumor budding (TB) in the recurrence and outcome of patients with Oral tongue squamous cell carcinoma (OTSCC).

Methods: All patients with OTSCC who underwent glossectomy with or without neck dissection in a tertiary center between 2010 and 2020 were included. The pathology slides of all patients were reviewed by a consulting pathologist. All pathologic features including tumor size, tumor grade, tumor thickness, surgical margin status, lymphovascular- and perineural invasion, T-stage, number of dissected, TB, TSR, and involved, tumor budding and tumor-stromal ratio were defined, we categorized the tumors as stroma-rich (low TSR) and stroma-poor (high TSR); as well as TB as low (0-4 buds) and high (≥ 5 buds). The inter-observer reliability of TB and TSR was assessed using the Kappa statistics analysis.

Results: A total of 109 patients, with a median age of 62 (range 19-88) years, were included. There was a significant correlation between TSR and tumor budding with other adverse pathologic features and prognostic factors. In univariate analysis, both stromal-rich tumors and tumor budding were poor prognostic factors for disease-free survival (DFS) and overall survival (OS). However, on multivariate analysis, N-stage, adjuvant radiotherapy, tumor size, depth of invasion (DOI) and tumor budding emerged as independent prognostic factors for DFS. Likewise, N-stage, and DOI were recognized as independent prognostic factors for OS.

Conclusion: Both TSR and TB are important histopathological parameters strongly linked to other pathologic prognostic indicators. Additionally, they play key roles in predicting tumor behavior, recurrence, and patient survival.