Editorial
Difference of WHO Pathological Grading among Different Depths in Oral Squamous Cell Carcinoma and Its Clinical Significance
Qiang Zhang1*, Kairui Chen1, Jiaxuan Qiu1, Yanlin Tan1, Xiayang Zhuo2, Yunxiang Jia2, Zhongyi Cao1, Junfeng Yan1 and Youchun Wei1
1Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi, China
2Department of Oral Pathology, Affiliated Stomatological Hospital of Nanchang University, Jiangxi, China
*Corresponding author: Qiang Zhang, Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi China
Published: 12 Jun, 2017
Cite this article as: Zhang Q, Chen K, Qiu J, Tan Y, Zhuo
X, Jia Y, et al. Difference of WHO
Pathological Grading among Different
Depths in Oral Squamous Cell
Carcinoma and Its Clinical Significance.
Clin Surg. 2017; 2: 1506.
Abstract
Due to the heterogeneity of malignant tumors, the distribution and arrangement of tumor
cells within the same tumor is un uniform. So preoperative biopsy and postoperative pathologic
examination can not reflect precisely tumor biological characteristics and prognosis. In this
project, oral squamous cell carcinoma specimen was divided into surface, central area and deep
infiltrating depth and WHO pathological grade was observed respectively in each depth and to
study the difference and its clinical significance. 35 oral squamous cell carcinoma patients without
preoperative radiotherapy and chemotherapy were included. The pathological specimens were
collected from surface, centra, deep infiltration depth in each patient. The average age of the patients
was 55.9 years old (range from 29 to 71 years old); in which there were a total of 19 males and 16
females; with a total of 7 cases of cheek, 14 case in tongue, 9 cases in gingival, and 5 cases in floor
of mouth; TNM stage: T1 in 4 cases, T2 in 16 cases, T3 in 8 cases, and T4 in two cases. After the
localization (surface, central, deep), 35 cases of squamous cell carcinoma were graded respectively
of the 3 depth by oral pathologist, and the WHO standard was adopted. Because WHO classification
was a semi quantitative index, Radit analysis method was used. Radit analysis: X(0.01)3=11.345, P<
0.01. The results showed that there were significant differences in the WHO pathological grading
among surface, central and deep infiltrating depth. Among them, the surface area with the center
area, surface area with deep infiltrating area, central area with deep infiltrating area were different
(P< 0.05), and compared from the surface to the central area of the area to the deep infiltrating area,
differentiation is getting worse and the deep infiltrating area was the highest in pathological grade.
The tumor of human body, especially malignant tumor, is composed of cells with different
pathological and biological behavior. The heterogeneity of tumor mainly refers to the difference of
tumor cells in the same tumor due to different tumor cell line. The internal structure of the tumor is
very complex. Therefore, preoperative biopsy and postoperative pathological tissue might not always
contain the most invasive cells which could accurately reflect the tumor biological characteristics.
This will affect the significance of prognosis and whether the design is correct or not. The results of
the treatment of different researchers will lose comparable.
It is believed that the lower the degree of tumor differentiation, the higher the degree of
malignancy, the worse the prognosis. However, in recent years, there have been a lot of reports
about the relative contradiction between the pathological grade and prognosis of oral squamous
cell carcinoma. Bryne found Broder's grade I, II, III of oral cancer patients with 5 year survival rate
was 34%, 41%, 24% respectively. More et al. found that WHO pathological grade was not associated
with prognosis. The reasons for this relative contradiction may be caused by specimen selected area
were different, therefore, it is very necessary to put forward a reasonable and consensus area which
the specimen was gained.
The results of this study show that compared with surface and central depth, the deep infiltration
area, WHO grading difference was higher, differentiation is even worse, the invasion ability of the
cells may be located in the frontier area of tumor invasion. Therefore, the depth of infiltration
could reflect the biological characteristics of tumor. On the basis of these results, Bryne presented
the grading of infiltrating cells which showed that the prognosis was related. Previous reports of
inconsistence of WHO grade and prognosis might be with the sites of the authors selected were
uniform.