The density of metastatic lymph node as prognostic factor in squamous cell carcinoma of the tongue and floor of the mouth

The presence of metastatic lymph nodes is a relevant prognostic factor in oral cancer. Objective: This paper aims to assess metastatic lymph node density (pN+) in patients with tongue and floor-of-mouth squamous cell carcinoma (SCC) and the association of this parameter with disease-free survival (DFS). Materials and Methods: A group of 182 patients seen between 1985 and 2007 was included, 169 of which were males. Five were on stage I, 35 on stage II, 56 on stage III, and 85 on stage IV. Median values were considered in lymph node density assessment, and the Kaplan-Meier curve was used to evaluate DFS; survival differences within the group were elicited through the log-rank test. Results: An average 3.2 metastatic lymph nodes were excised from the patients in the group. Density ranged from 0.009 to 0.4, with a mean value of 0.09. Five-year DFS rates were of 44% and 28% for the groups with lymph node densities below and above the median respectively (p = 0.006). Two-year local/regional control was achieved for 71% and 49% for the patients below and above the median density respectively (p = 0.01). In terms of pN staging, local/regional control was achieved in 70% and 54% of pN1 and pN2 patients respectively, albeit without statistical significance (0.20%). Conclusion: Lymph node density may be used as a prognostic indicator for tongue and floor-ofmouth SCC

Valor prognóstico da metástase regional no carcinoma epidermoide de língua e soalho bucal

The presence of metastatic nodes is a survival-limiting factor for patients with mouth tumors.Objective: To evaluate the causes of treatment failure in carcinomas of the tongue and floor of the mouth due to staging.Method: This study included 365 patients with squamous cell carcinoma of the mouth treated from 1978 to 2007; 48 were staged as T1, 156 as T2, 98 as T3, and 63 as T4, of which 193 were pNo and 172 pN+.Results: Among the pN+ cases, 17/46 (36.9%) of the patients not treated with radiation therapy had relapsing tumors, against 46/126 (36.5 %) of the patients who underwent radiation therapy. Success rates in the group of subjects submitted to salvage procedures were 16/51 (31.3%) for pN0 patients and 3/77 (3.9%) for pN+ patients.Conclusion: Salvage procedure success and survival rates are lower for pN+ patients; pN+ individuals also have more relapsing local disease.Universidade Federal de São Paulo, São Paulo, BrazilHeliopolis Hosp, Dept Head & Neck Surg & Otorhinolaryngol, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Surg, BR-05508 São Paulo, BrazilHeliopolis Hosp, Dept Hlth, São Paulo, BrazilSao Jose Hosp, São Paulo, BrazilUNILUS, Sch Med Sci Santos, Santos, BrazilUniv São Paulo, Univ Hosp, Sch Med, Dept Head & Neck Surg & Otorhinolaryngol,Superbvi, BR-05508 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Head & Neck Surg, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Ameloblastoma demographic, clinical and treatment study - analysis of 40 cases

Dental lesions represent about 1% of oral cavity tumors being ameloblastoma the most common one. It is a tumor of epithelial origin that mainly affects the jaw, and less commonly the maxilla. Its clinical presentation is that of an asymptomatic slow-growing tumor. Despite being a benign tumor, it has an invasive behavior with a high rate of recurrence if not treated properly. Objective: To describe the cases of ameloblastoma in a reference department. Methods: Retrospective analysis of 40 cases. The variables analyzed were: age, gender, ethnicity, tumor location, type of treatment, complications and recurrence. Results: The most affected gender was male - 21 cases (52.5%); with a predominance of Caucasians - 24 cases (60%). The mean age was 35.45 years; the most common location was in.the jaw - 37 cases (92.5%). Facial asymmetry was the most frequent complaint. Of the 40 cases, 33 were submitted to surgery. Of those submitted to surgery, 24 (72.72%) underwent segmental resection, with recurrence in 4 (12.12%) cases. Conclusion: Ameloblastoma may relapse when treatment is not performed with broad surgical resection of the lesion with wide safety margins

Update of Assessment of Survival in Head and Neck Cancer after Regional Recurrence

Objective. To evaluate site of regional recurrence in patients with squamous cell carcinoma of upper aerodigestive tract after neck dissection and the results of salvage treatment. Methods. 95 patients with regional recurrence as the first manifestation of relapse were selected between 943 patients who underwent neck dissection. We evaluated level and side of recurrence, as well disease control after salvage treatment. Results. Level II was the most frequent site of recurrence. Salvage treatment was performed in 51% of ipsilateral and in 75% of contralateral (nondissected neck) recurrences. Control of the disease 12 months after salvage surgery was 25% in the ipsilateral and 37% in contralateral recurrences. Conclusions. Cervical recurrences occur predominantly in level II. Relapse in level I is frequent only in oral cavity tumors and relapse in level V is rare. The neck recurrence carries a poor prognosis even among patients who underwent retreatment with curative intent

Avaliação epidemiológica e da resposta terapêutica no câncer da hipofaringe

Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality.Objective: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer.Method: We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma.Results: the mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. the main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). the clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). the treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment.Conclusion: Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.Fed Univ São Paulo UNIFESP, São Paulo, BrazilHeliopolis Hosp, Dept Head & Neck Surg & Otorhinolaryngol, São Paulo, BrazilLusiada Fdn, Dept Surg, Sch Med Sci, Santos, SP, BrazilSao Jose Hosp RBBP, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Surg, BR-05508 São Paulo, BrazilHeliopolis Hosp, Dept Hlth, São Paulo, BrazilSao Jose Hosp, RBBP, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Head & Neck Surg, Larynx Grp, BR-05508 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Head & Neck Surg, BR-05508 São Paulo, BrazilFed Univ São Paulo UNIFESP, São Paulo, BrazilWeb of Scienc

GTSP1 expression in non-smoker and non-drinker patients with squamous cell carcinoma of the head and neck

<div><p>Introduction</p><p>The main risk factors for head and neck squamous cell carcinoma (HNSCC) are tobacco and alcohol consumption and human papillomavirus (HPV) infection. However, in a subset of patients, no risk factors can be identified. Glutathione S-transferase π (GTSP1) is a carcinogen-detoxifying enzyme that is activated by exposure to carcinogens, and it is associated with a reduction in response to toxic therapies. We studied the expression of GTSP1 in tumor and non-tumor tissue samples from patients with and without these risks to identify whether GTSP1 expression differs according to exposure to carcinogens.</p><p>Materials and methods</p><p>Non-smoker/non-drinker (NSND) and smoker/drinker (SD) patients were matched according to age, gender, tumor site, TNM stage, grade and histological variants to establish 47 pairs of patients who have been previously tested for HPV. GTSP1 immunostaining was analyzed using a semi-quantitative method with scores ranging from 0 to 3 according to the area of immunostaining.</p><p>Results</p><p>GTSP1 expression was detected in the tumors of both groups. GTSP1 expression was higher in the non-tumor margins of SD patients (<i>p = 0</i>.<i>004</i>). There was no association between GTSP1 expression and positivity for HPV. No differences in survival were observed according to GTSP1 staining in tumors and non-tumor margins.</p><p>Conclusion</p><p>This study showed that GTSP1 was expressed in tumors of HNSCC patients regardless of smoking, drinking or HPV infection status. The difference in GTSP1 expression in non-tumor margins between the two groups may have been due to two possible reasons. First, elevated GTSP1 expression in SD patients might be the result of activation of GTSP1 in response to exposure to carcinogens. Second, alternatively, impairment in the detoxifying system of GTSP1, as observed by the reduced expression of GTSP1, might make patients susceptible to carcinogens other than tobacco and alcohol, which may be the underlying mechanism of carcinogenesis in the absence of risk factors.</p></div

Expression of GTSP1 via immunohistochemistry.

<p>A: High expression of GTSP1 in non-tumor margin; B: low expression of GTSP1 in non-tumor margin; C: high expression of GTSP1 in tumor.</p

Overall survival of NSND patients according to GTSP1 expression.

<p>A: GTSP1 expression in non-tumor margins; B: GTSP1 expression in tumors.</p

GTSP1 expression according to smoking and drinking habits.

<p>A: GSTP1 expression in non-tumor margins; B: GSTP1 expression in tumor.</p

Clinical features of the paired samples.

<p>Clinical features of the paired samples.</p