# Proposed modified Brandwein-Gensler histological risk assessment score as prognosticator in oral squamous cell carcinoma

## TL;DR

This study modifies a histological risk score for oral cancer to better predict patient outcomes based on tumor features and immune response.

## Contribution

A modified Brandwein-Gensler score incorporating invasion patterns, perineural invasion, and lymphocytes is proposed as a more accurate prognostic tool.

## Key findings

- The modified score showed significant association with pathological node involvement and tumor grading.
- High score tumors exhibited poor differentiation, deeper invasion, and lower survival rates.
- The score correlated with overall survival and lymph node involvement in oral squamous cell carcinoma patients.

## Abstract

Histopathological parameters significantly impact the prognosis and treatment strategies of oral squamous cell carcinoma (OSCC). Various risk assessment scores and grading systems have been proposed in the past, primarily based on subjective assessment of microscopic features. To modify Brandwein-Gensler risk score by including the worst pattern of invasion-5, perineural invasion and percentage stromal tumor infiltrating lymphocytes(TILs) and evaluate the relationship of the modified score with clinicopathological variables.

This retrospective observational study was conducted on 58 OSCC patients. The density of stromal TILs was determined on routine microscopic sections using image analysis software, thereby quantifying lymphocytic host response as percentage stromal lymphocytes. Furthermore, the modified Brandwein-Gensler risk score was derived from the assessment of the worst pattern of invasion-5, perineural invasion and percentage stromal tumor infiltrating lymphocytes. Chi-square test and Univariate analysis were used to find the association of categorical and continuous variables. The Kaplan-Meier and log-rank tests were used to estimate the survival rates.

A significant positive association of modified Brandwein-Gensler score was observed with pathological node (p=0.005), tumor grading (p=0.025), depth of invasion(p=0.016) and overall survival (p=0.03), signifying that high score tumors showed poor differentiation, invasive features and lower survival time.

A modified, simplified and objective version of Brandwein Gensler histological risk assessment score is derived, revealing a significant association with tumor differentiation, depth of invasion and lymph node involvement.