Radiological Sublingual Space Invasion in Tongue Squamous Cell Carcinoma: Clinicopathological Associations and Impact on Survival

Anna See; Min-Cun Yang; Yenlin Huang; Tsung-You Tsai; Chi-Yin Lee; Pin-Hsuan Huang; Ti-Yung Tseng; Shu-Hang Ng; Kai-Ping Chang

doi:10.1002/ohn.1097

Radiological Sublingual Space Invasion in Tongue Squamous Cell Carcinoma: Clinicopathological Associations and Impact on Survival

Otolaryngol Head Neck Surg. 2024 Dec 22. doi: 10.1002/ohn.1097. Online ahead of print.

Authors

Anna See^{1

2}, Min-Cun Yang¹, Yenlin Huang^{3

4

5}, Tsung-You Tsai¹, Chi-Yin Lee¹, Pin-Hsuan Huang⁶, Ti-Yung Tseng⁷, Shu-Hang Ng⁷, Kai-Ping Chang^{1

8}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore.
³ Department of Pathology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁴ School of Medicine, National Tsing-Hua University, Hsinchu, Taiwan.
⁵ Institute of Stem Cell and Translational Cancer Research, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁶ Center for Big Data Analytics and Statistics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁷ Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁸ College of Medicine, Chang Gung University, Taoyuan, Taiwan.

PMID: 39709539
DOI: 10.1002/ohn.1097

Abstract

Objectives: We investigate if sublingual space invasion (SLI) determined on magnetic resonance imaging confers differences in clinicopathological manifestations and treatment outcomes of oral tongue squamous cell carcinoma (OTSCC).

Study design: Retrospective cohort study.

Setting: Tertiary Academic Medical Center.

Methods: 221 OTSCC patients were included. Cox regression models and Kaplan-Meier methods were used, and nomogram construction was performed, incorporating SLI with other adverse factors, to predict the prognosis.

Results: On multivariable analysis, the following were associated with cervical nodal metastasis: (1) greater MRI T classification of T3/T4 versus T1/T2: adjusted odds ratio (aOR) 2.784, 95% CI = 1.459 to 5.313, P = .001; (2) gender (female vs male): aOR 4.117, 95% CI = 1.602 to 10.576, P = .003; (3) presence of MRI-determined SLI: aOR 2.588, 95% CI = 1.393 to 4.808, P = .002. For survival outcomes, extranodal extension (adjusted hazard ratio [aHR]: 3.380, 95% CI = 2.024-5.644, P < .001), poorly-differentiated type (aHR: 1.720, 95% CI = 1.006-2.943, P = .047), lymphovascular invasion (aHR: 2.100, 95% CI = 1.220-3.614, P = .007), and SLI (aHR: 1.700, 95% CI = 1.086-2.661, P = .020) were statistically significant prognosticators of disease-free survival. In overall survival, when controlled for age, gender, overall TNM stage, Charlson morbidity index, surgical margins, depth of invasion and adjuvant therapy, SLI was a statistically significant prognosticator (aHR: 1.622, 95% CI = 1.012-2.602, P = .044). A proposed novel nomogram for overall survival combining SLI and other risk factors showed a higher concordance index compared to a nomogram with TNM staging alone (0.783 vs 0.629, P < .001).

Conclusion: SLI is an independent prognostic factor for treatment outcomes in OTSCC. Incorporating SLI into a novel nomogram demonstrated improved predictive accuracy for post-treatment outcomes.

Keywords: OSCC; head and neck; oral cavity; squamous cell carcinoma; sublingual space; tongue.