In patients with oral cancer, unfavourable clinical and histological features may require postoperative radiotherapy or chemoradiation. Our study investigated the impact of the invasive front of the tumor on oncological outcomes. In our cohort, we investigated the impact of worst pattern of infiltration (WPOI) and tumor budding (TB) on oncological outcomes. We included 142 patients with primary oral cancer in our prospective cohort study. We excluded 19 patients with other malignancy than oral squamosus cell carcinoma. Two groups were created of 123 cases based on WPOI; (Group A (WPOI 1–4) 39 cases - Group B (WPOI 5) 84 cases). The TB score was determined from the analysis of the postoperative sample. Locoregional control, overall and disease-specific survival were assessed after 39.8 months. Disease-specific survival and overall survival in group A were 97.5% and 87.1%, in group B 81% and 51.2%. Looking at early-stage tumors separately, cervical lymph node metastasis was confirmed in 13,6% of group A and 56% of group B. A TB score ≥ 3 was associated with a higher risk of metastasis. In patients with the best risk factor profile (cT1–2, WPOI1–4, TB ≤ 3), an occult cervical metastasis rate of 4.7% and no disease specific mortality was observed. WPOI 5 is a reliable predictor of worse oncological outcome, and Tumor Budding may provide additional prognostic information. Examining and categorization of the tumor-host interface may give rationale to perform staged elective neck dissection, based on the histopathological result. • Worst pattern of invasion front of oral cancer have a pronounced effect on oncological outcome. • Tumor budding may be used as additive information on the prognosis of oral cancer patients. • Combining WPOI and TB predicts occult neck metastases more accurately than DOI. • Depending on the histological findings, staged elective neck dissection may be justified.
Csizmazia et al. (2026) studied this question.