Prognostic Significance of a Novel Histopathologic Risk Model Incorporating Modifications to the Worst Pattern of Invasion and Tumor Budding for Oral Squamous Cell Carcinoma

Background Prognostic stratification to predict patient outcomes and guide treatment decisions is urgently needed to improve clinical management of oral squamous cell carcinoma (OSCC). This study evaluated the prognostic performance of a novel histopathologic risk model that integrates modifications to the worst pattern of invasion (WPOI) system and tumor budding (TB) classification for OSCC, focusing on its effectiveness in predicting recurrence and survival. Methods In a retrospective study of 193 OSCC cases, the modifications incorporated to the WPOI and TB were initially compared to conventional assessments. Next, the effectiveness of the novel histopathologic risk model was assessed. Univariate and multivariate survival analyses were performed using Cox proportional hazards models. The performance of the classifiers was evaluated by applying the receiver operating characteristic (ROC) analysis, calculating the area under the curve (AUC). Results Classical WPOI was significantly and independently associated with shortened cancer‐specific survival (HR = 2.0, 95% CI = 1.26–3.25, p = 0.003); whereas classical TB was associated with poor disease‐free survival (HR = 2.17, 95% CI = 1.25–3.74, p = 0.005). In contrast, the modified WPOI and TB showed no significant associations with patient outcomes. The novel histopathologic risk model, which categorized 68.4% of cases as intermediate risk, showed limited ability to predict OSCC outcomes. Conclusions The findings of this study show the superior prognostic value of the classical WPOI and TB over their modified counterparts; the potential of the novel histopathologic risk was not validated in this cohort including OSCCs at all clinical stages.