The prognostic significance of the ‘Worst Pattern of Invasion’ in oral cancers−an international collaborative multicentre analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Worst pattern of invasion (WPOI) has been evaluated in many single-institute cohorts. Our goal was to perform a large multicentre evaluation of WPOI as a prognostic marker in oral squamous cell carcinoma (OSCC). Retrospective pathology data was collated from 14 institutions and compared with clinical outcome in 1374 OSCC patients with upfront curative resection. Most cases were of oral tongue (n = 645, 47%); T2 (33%) and N0 (59%). WPOI 1-3 frequency was 29.4%, WPOI 4 47% and WPOI 5 22%. On univariable analysis, the 3-year disease free survival (DFS) was 54.2% for WPOI 5 vs. 69.7% for WPOI 1-4 (p < 0.001). The locoregional control (LRC) was 68.9% vs 79.2% (p = 0.001), and overall survival (OS) 68.4% vs 83.8% (p < 0.001). On multivariable Cox-regression in the entire cohort, WPOI 4 or 5 was strongly correlated with other known poor prognostic factors and not an independent predictor of OS (HR 1.10, 95% CI 0.92-1.52), LRC or DFS. However, in early-stage (pT1-2 N0) patients treated with surgery alone without adjuvant radiotherapy, WPOI 5 was a robust independent predictor of DFS (HR 4.36, 95% CI 1.54-12.32, p = 0.006), OS (HR 3.69, 95% CI 1.23-11.1, p = 0.020) and LRC (HR 3.52, 95% CI 2.13-5.82, p <0.001) after applying inverse probability weighting to correct for selection bias. Furthermore, in the entire cohort of early-stage patients, interaction modeling showed that adjuvant radiotherapy significantly reduces the risk for both DFS and LRC for those with WPOI-5 (Interaction p = 0.002). Therefore, it may act as a predictive biomarker for the benefit of adjuvant radiotherapy. The prognostic and predictive role of WPOI-5 should be validated in prospective trials.
Source: Oral Oncology
Authors: Paromita Roy, Margaret Brandwein Weber, Ruta Gupta, Aanchal Kakkar, Daphne Fonseca, Munita Bal, Meenakshi Kamboj, Nidhi Anand, K.R. Anila, Shanthi Velusamy, Megha Shantveer Uppin, Suvradeep Mitra, Meera Thomas, Poonam Abhay Elhence, Indu Arun, Sunil Pasricha, Nuzhat Husain, Rekha V. Kumar, Amanjit Bal, Asawari Patil, Shubhada V. Kane, Shantveer G. Uppin, Anand Bardia, Shivani Sarkar, Sahithi Shilpa Arya, Reshma Kurian, R. Chitra, Pramod Kumar Pamu, Christina Wiedmer, Jenny Tung Hiong Lee, Ritu Srivastava, Akhila Gopakumar, Tsu-Hui Hubert Low, Mark Urken, Jerry Liu, Deepa Nair, Rajsekhar Shantappa, Sarthak Tandon, Shaji Thomas, Cessal Thomas, Jeevan Ram Vishnoi, Kapila Manikantan, Pattatheyil Arun, Sanjoy Chatterjee, Indranil Mallick
Institutions: Tata Medical Center, Icahn School of Medicine at Mount Sinai, Royal Prince Alfred Hospital, NSW Health Pathology, All India Institute of Medical Sciences, Basavatarakam Indo American Cancer Hospital and Research Institute, Homi Bhabha National Institute, Tata Memorial Hospital, Rajiv Gandhi Cancer Institute and Research Centre, Dr. Ram Manohar Lohia Institute of Medical Sciences, Regional Cancer Center, Thiruvananthapuram, Sri Shankara Cancer Hospital and Research Center, Nizam's Institute of Medical Sciences, Post Graduate Institute of Medical Education and Research, Christian Medical College, Vellore, All India Institute of Medical Sciences Jodhpur, Jaslok Hospital, Macquarie University
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,720
OpenAlex ID: W7127266161