Avtor/Urednik		Čizmarevič, Bogdan; Lanišnik, Boštjan; Didanovič, Vojko; Kramberger, Kristina
Naslov		Combined therapy for oral cavity and oropharyngeal squamous cell carcinoma: Depth of invasion as prognostic factor
Prevedeni naslov		Kombinirano zdravljenje ploščatoceličnega karcinoma ustne votline in ustnega žrela. Globina tumorske invazije kot napovedni dejavnik
Tip		članek
Vir		Radiol Oncol
Vol. in št.		Letnik 35, št. 4
Leto izdaje		2001
Obseg		str. 255-8
Jezik		eng
Abstrakt		Background. The aim of the study was to emphasize the importance of surgical management of squamous cell carcinoma (SCC) in the head and neck and to find the most important predictive factor for cervical lymph node metastasis and prognostic factor for survival. The use of multimodality therapy is being discussed as well. Patients and methods. From June 1st, 1992 to May 31st, 1998; 154 patients with oral cavity and oropharyngeal SCC were admitted to the Department of Otorhinolaryngology and Cervicofacial Surgery in the Teaching Hospital of Maribor. The criteria for inclusion into the study were met by 142 patients, but only 62/142 patients entered the multimodality protocol (surgery and postoperative radiotherapy). These 62/142 patients were treated surgically and 49 of them were postoperatively irradiated, while 13/62 declined postoperative radiotherapy. Surgical specimen was evaluated for positive or negative lymph nodes, tumor margins and the depth of invasion. Tumor cells were stained for Ki67 proliferative factor. Results. The depth of invasion was the most important predictive factor for the neck metastases in multivariate model including also the grade, pT and T. pN was found to be important in determining the overall survival using Cox regression model (p < 0,05). A statistically important discrepancy between N and pN classification was found. In 23 cases N was overrated and in 3 cases underrated. The overall 5-year disease specific survival was 55%. Ki67 correlated with the grade of tumor differentiation. No statistically significant correlation was found with lymph node metastases. Conclusions. The depth of invasion is the most important factor determining the occurrence of the neck metastases whereas the N status determines the survival.
Izvleček		Izhodišča. V raziskavi smo nameravali ugotoviti pomembnost kirurškega zdravljenja ploščatoceličnega karcinoma glave in vratu ter najti najpomembnejši napovedni dejavnik za širjenje karcinoma v vratne bezgavke in določiti, kateri dejavnik v največji meri vpliva na preživetje bolnikov. Bolniki in metode. Od 1. 6. 1992 do 31. 5. 1998 smo na Oddelku za otorinolaringologijo in cervikofacialno kirurgijo Učne bolnišnice v Mariboru obravnavali 154 bolnikov s ploščatoceličnim karcinomom ustne votline in ustnega žrela. Kriterijem naše retrospektivne študije je ustrezalo 142 bolnikov, a le 62 je bilo primernih za kombinirano zdravljenje s kirurgijo in pooperativno radioterapijo. Od 62/142 operairanih bolnikov je bilo 149 tudi pooperativno obsevanih, 13/62 bolnikov pa je odklonilo nadaljnje zdravljenje. Na kirurškem resektatu smo ugotavljali, ali tumor zaseva v vratne bezgavke, ali je bil izrezan v zdravo in kakšna je bila globinska invazija tumorja. Prav tako smo na tumorskih celicah določali proliferativni faktor Ki67. Rezultati. V multivariantni analizi, ki je vključevala tudi stopnjo diferenciacije tumorja, klinični in patološki stadij tumorja (T in pT), je bila globina tumorske invazije najvažnejši napovedni dejavnik za širjenje karcinoma v vratne bezgavke. Ob uporabi Coxovega regresijskega modela pa je bila patohistološka opredelitev prizadetosti bezgavk (pN) pomemben dejavnik za preživetje bolnikov (p < 0,05). Našli smo statistično pomembno razliko med klinično in patološko opredelitvijo prizadetosti vratnih bezgavk (N in pN). V 23 primerih so bile bezgavke napačno ocenjene kot prizadete s tumorskimi celicami, v 3 primerih pa so bile spregledane. Celotno 5-letno preživetje bolnikov je bilo 55 %. Izražanje Ki67 je bil odvisno od stopnje diferenciacije tumorja in statistično značilne povezave s širjenje karcinoma v vratne bezgavke nismo ugotovili. (Izvleček skrajšan pri 2000 znakih)
Deskriptorji		MOUTH NEOPLASMS OROPHARYNGEAL NEOPLASMS CARCINOMA, SQUAMOUS CELL COMBINED MODALITY THERAPY SURVIVAL ANALYSIS