Triple Positive Oral Squamous Cell Carcinoma Patients Predict Poor Survival Outcomes: Multiple Factor Positivity Warrants the Need for Modified Treatment Approaches

Priyansh Jain; Mahesh Sultania; Dillip Muduly; Itisha Chaudhary; Hemanth Ghalige; Sangram Patro; Amit Adhya; Madhabananda Kar

doi:10.1007/s12663-024-02186-5

Triple Positive Oral Squamous Cell Carcinoma Patients Predict Poor Survival Outcomes: Multiple Factor Positivity Warrants the Need for Modified Treatment Approaches

J Maxillofac Oral Surg. 2024 Aug;23(4):923-934. doi: 10.1007/s12663-024-02186-5. Epub 2024 Apr 29.

Authors

Priyansh Jain¹, Mahesh Sultania², Dillip Muduly¹, Itisha Chaudhary¹, Hemanth Ghalige¹, Sangram Patro¹, Amit Adhya³, Madhabananda Kar¹

Affiliations

¹ Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha India.
² Department of Head and Neck Oncology, Bagchi Sri Shankara Cancer Centre and Research Institute, Bhubaneswar, Odisha India.
³ Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha India.

PMID: 39118932
PMCID: PMC11303734 (available on 2025-08-01)
DOI: 10.1007/s12663-024-02186-5

Abstract

Objectives: The presence of lymphovascular invasion (LVI), perineural invasion (PNI) and extranodal extension (ENE) have shown adverse outcomes in oral squamous cell carcinoma (OSCC). This study evaluated the impact of LVI, PNI and ENE, individually and in combination, on survival outcomes in OSCC.

Material and methods: A retrospective analysis of a prospectively maintained oral cancer database was done from January 2017 to March 2023. All consecutive OSCC patients who underwent curative intent surgery were included. The triple-positive group was defined by the presence of all three features (LVI/PNI/ENE), while the double-positive group had the presence of two features. The disease-free survival (DFS) and overall survival (OS) analysis was done between different study groups.

Results: A total of 255 patients were included in the analysis. The LVI, PNI and ENE positivity was 13%, 26% and 11%, respectively. There were 19 patients (7%) with double-positive and ten patients (4%) with triple-positive disease. The triple-positive group had lower DFS than non-triple-positive (0% vs 57%, p-value 0.001) and lower OS (0% vs 72%, p-value 0.003). The median DFS and OS of the triple-positive group were eight months and 24 months, respectively. Similarly, the double-positive group also had statistically significant inferior DFS (p-value 0.007) and OS (p-value 0.002) compared to the single-positive/triple-negative group.

Conclusion: The triple-positive disease had poor outcomes, with no patients achieving disease-free or overall survival at the 5-year follow-up. The presence of multiple adverse factors necessitates modification of adjuvant therapy and therapeutic strategy, which may enhance survival outcomes.

Keywords: Disease-free survival; Extranodal extension; Head and neck cancer; Lymphovascular invasion; Oral cancer; Perineural invasion; Prognosis; Survival analysis.

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