Abstract:

Objective: This study aims to validate the prognostic performance of the Brandwein-Gensler histologic risk assessment system in a homogeneous cohort of early-stage oral tongue squamous cell carcinomas (SCC). Specifically, it evaluates the system’s ability to predict overall survival and the presence of occult metastases.
Materials and Methods: A total of 72 patients with early-stage (T1–T2) oral tongue SCC were retrospectively analyzed. Sixty of these cases were classified using the Brandwein-Gensler risk system, which considers three histologic parameters: worst pattern of invasion (WPOI), lymphocytic host response (LHR), and perineural invasion (PNI). Overall survival (OS) was assessed using Kaplan-Meier and Cox regression analysis. The system’s prognostic accuracy was tested using receiver operating characteristic (ROC) analysis. Correlations with occult metastases were also examined.
Results: Statistically significant differences in OS were observed between risk groups (p = 0.01), with high-risk patients exhibiting a threefold increased mortality risk (p = 0.012). The ROC analysis demonstrated moderate discriminatory power (AUC = 0.702). However, the system did not show a statistically significant correlation with the development of occult metastases (p = 0.49).
Conclusion: The Brandwein-Gensler system is a valid prognostic tool for overall survival in early-stage oral tongue SCC, successfully identifying patients at increased risk of death. Its role in predicting occult metastases remains inconclusive and warrants further investigation.

Keywords: oral tongue cancer, squamous cell carcinoma, histologic risk model, Brandwein-Gensler, prognosis, survival, occult metastasis