MRI-based tumor signatures as prognostic biomarkers in oral tongue squamous cell carcinoma

Introduction This study evaluated the prognostic significance of MRI features—peritumoral hyperenhancement, peritumoral hyperenhancement width, peritumoral edema, tumor ulceration, and tumor 5 mm from the hyoid bone—in patients with oral tongue squamous cell carcinoma. Outcomes assessed included overall survival (OS), recurrence-free survival (RFS) local (LRFS), locoregional (LRRFS), and distant (DRFS), and disease-free survival (DFS). The secondary objectives included associations with perineural invasion (PNI) and extranodal extension (ENE) on histopathology. Materials and methods A retrospective cross-sectional study was conducted at a tertiary cancer center, including 221 treatment-naive oral tongue squamous cell carcinoma patients who underwent surgery between January 2021 and December 2022. Pre-treatment MRIs were reviewed by two blinded radiologists. Patients were followed up for 2 years. Univariate and multivariate analyses were performed. Categorical associations were evaluated using Fisher’s exact or chi-squared tests ( p 0.05). Results The cohort comprised 221 patients (179 men and 42 women), with a mean age of 47.1 ± 10.88 years. Tumor 5 mm from the hyoid was associated with worse OS hazard ratio (HR): 3.05; p = 0.034, DRFS (HR: 4.66; p = 0.041), and DFS (HR: 3.68; p = 0.007), peritumoral edema predicted worse DRFS (HR: 4.77; p = 0.036), and pathological T categories predicted inferior OS and DFS in multivariate analyses. Peritumoral hyperenhancement and tumor ulceration predicted inferior OS and DFS, respectively, in univariate analyses. These variables were linked to ENE, while peritumoral hyperenhancement width 2.65 mm was associated with PNI. Conclusion Peritumoral edema, tumor ulceration, peritumoral hyperenhancement (and width 2.65 mm), and tumor 5 mm from the hyoid bone are adverse MRI biomarkers in oral tongue squamous cell carcinoma, which can refine risk stratification and inform future T4 staging, warranting prospective validation in larger cohorts.