The influence of histological grading on prognosis in carcinoma of the tongue (a computer analysis of 299 cases)

A method of grading by ‘scoring’ points is described, based on keratinisation, mitoses and hyperchromatism and cellular and nuclear irregularity. Clinical and histological data on 299 cases of cancer of the tongue are presented using a computer generated Integral Survival Index as a measure of prognosis. The relationship of histological grade to survival and its influence in correllation with staging, sex, site and treatment by external radiotherapy are discussed. The expectation of life of these patients proved to vary from 73·7% of normal for Stage 1 Grade I tumours to 20% for Stage 3 Grade III tumours, and a relationship between prognosis and both histological grading and clinical staging is shown. These results suggest that radiotherapy may be preferable to block dissection for node metastases from undifferentiated tumours, even when technically operable, but that the converse is true for the well differentiated ones. The difference in prognosis between the sexes appears to show some relationship to histological grade and the implications of this are discussed. It is uncommon for well differentiated tumours to develop marked local infiltration before lymph node metastases have occurred. Tumours of the posterior third are mostly of undifferentiated type and this is the principle factor accounting for their poorer prognosis.