WORST PATTERN OF INVASION IN ORAL SQUAMOUS CELL CARCINOMA: AN INDEPENDENT PROGNOSTIC INDICATOR

Oral cancer is one of the most often diagnosed types of the disease in Pakistan (Globocan, 2020 Pakistan). Squamous cell carcinomas account for over 90% of oral cancers (Anwar et al., 2020) . Several indicators point to a poor prognosis for OSCC, such as advanced tumor stage, higher tumor grade, extra capsular extension, nodal metastases, greater depth of invasion, lymphovascular invasion, poor differentiation, positive surgical margins, and perineural invasion have all been shown to be related with poor prognosis of patients with OSCC (Khan et al., 2023) . These factors have been rarely evaluated in Pakistani population.

Although there have been significant advances in the management of other types of cancer, OSCC still has few therapeutic options. The overall five-year survival rate for this illness remains about 50% despite substantial study over the preceding few decades.

(Chen et al., 2018) . Surgery followed by adjuvant radiation therapy and/or chemotherapy is still considered the gold standard for treating cancer. Early stage oral tongue carcinomas that are 4 mm or deeper at diagnosis, or that have a development pattern of small cell islands or satellites, should be treated as high-risk tumors requiring a multimodal approach (Lakhera et al., 2023) . Previous research into the significance of tumor budding in oral cavity malignancies has linked it to increased rates of lymph node metastases, relapse, and poor overall survival.

(Almangush et al., 2018) .Similar is seen with tumours that have greater depth of invasion. (Moeckelmann N, 2018)

The invasive tumor front is the transition zone between the tumors and the surrounding stroma. The infiltration pattern of tumors at the tumor front has been studied in a few prior investigations. (Chatterjee et al., 2019) This needs separate attention now as The College of American Pathologists now includes the reporting of oral cavity cancers based on the patterns of tumor invasion but they are not well-established prognostic variables.