Fatores clínicos e histológicos preditivos de metástase cervical em carcinomas epidermóides de língua e soalho de boca no estadio clínico II

Soares, João Marcos Arantes; Rapoport, Abrão; Rosas, Marilene Paladino; Carvalho, Marcos Brasilino de; Fava, Antônio Sérgio

doi:10.1590/S0100-69911998000100006

Resumos

O encontro de fatores preditivos de metástase cervical seria de grande valia para o tratamento de pacientes com tumores de alto potencial metastatizante e com pescoço clinicamente negativo. Procuramos encontrar fatores clínicos e histológicos em tumores iniciais de língua e soalho de boca que pudessem indicar a realização de um esvaziamento cervical eletivo.Foram estudados os seguintes fatores: sexo, idade, tabagismo, etilismo, raça, tamanho da lesão, sítio primário, dor, tempo de queixa, primeira queixa, aspecto macroscópico da lesão, infiltrado inflamatório peritumoral, grau de diferenciação da biópsia, desmoplasia, invasão vascular, invasão perineural e número de mitoses por 10 campos de maior aumento. Nenhum dos fatores estudados foi capaz de predizer a ocorrência de metástase cervical no período pré-operatório. Acreditamos que outros fatores devam ser estudados e explorados para que se consiga indicar o esvaziamento cervical eletivo de modo criterioso para o tratamento destas lesões.

Neoplasias da língua; Neoplasias bucais; Metástases linfáticas; Histologia

The authors present a retrospective study of 54 patients with squamous cell carcinoma (SCC) of the fongue and floor of the mouth in stage II. The determination of clinical and hystological predictive factors of neck metastasis were the main proposal in T2 NO cases submitted to surgical approach at the Head and Neck Service of Heliópolis Hospital, Hosphel, from 1977 till 1993. The clinical aspects (location, size, alcohol, tabacco, sex, race, age, complain) and histological (macroscopy, injlammatory infiltration, differenciation degree, desmoplasia, mitoses number, vascular and perineural invasion) factors were analysed, using the K square statistical method with 2 x 2 tables and p less than 0.05. Concerning the outcomes for neck nodes metastases, 35.2% were positive coincident, 24.2% false negatives and 52.3% false positives. As conclusion, the main question of this paper were not obtained, due to the impossibility to determine the relation of predictive factors and natural history of the neoplasias of tongue and floor of the mouth.

Tongue neoplasms; Mouth neoplasms; Node metastasis; Histology

ARTIGOS ORIGINAIS

Fatores clínicos e histológicos preditivos de metástase cervical em carcinomas epidermóides de língua e soalho de boca no estadio clínico II

Predictive clinical and histological factors for neck metastasis in squamous cell carcinoma (scc) of the tongue and floor of the mouth (stage II)

João Marcos Arantes Soares, ACBC.SP^I; Abrão Rapoport, TCBC.SP^II; Marilene Paladino Rosas^III; Marcos Brasilino de Carvalho^IV; Antônio Sérgio Fava^V

^IMestre em Cirurgia de Cabeça e Pescoço do Hospital Heliópolis

^IILivre-Docente em Cirurgia de Cabeça e Pescoço. Coordenador do Curso de Pós-Graduação em Cirurgia de Cabeça e Pescoço do Hospital Heliópolis

^IIIMédica do Serviço de Anatomia Patológica do Hospital Heliópolis

^IVDoutor em Cirurgia de Cabeça e Pescoço. Chefe do Serviço de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis

^VDoutor em Cirurgia de Cabeça e Pescoço, Diretor Clínico do Hospital Heliópolis

^{Endereço para correspondência} Endereço para correspondência: Prof. Abrão Rapoport Praça Amadeu Amaral, 47, cj. 82 01327-010 - São Paulo - SP

RESUMO

O encontro de fatores preditivos de metástase cervical seria de grande valia para o tratamento de pacientes com tumores de alto potencial metastatizante e com pescoço clinicamente negativo. Procuramos encontrar fatores clínicos e histológicos em tumores iniciais de língua e soalho de boca que pudessem indicar a realização de um esvaziamento cervical eletivo.Foram estudados os seguintes fatores: sexo, idade, tabagismo, etilismo, raça, tamanho da lesão, sítio primário, dor, tempo de queixa, primeira queixa, aspecto macroscópico da lesão, infiltrado inflamatório peritumoral, grau de diferenciação da biópsia, desmoplasia, invasão vascular, invasão perineural e número de mitoses por 10 campos de maior aumento. Nenhum dos fatores estudados foi capaz de predizer a ocorrência de metástase cervical no período pré-operatório. Acreditamos que outros fatores devam ser estudados e explorados para que se consiga indicar o esvaziamento cervical eletivo de modo criterioso para o tratamento destas lesões.

Unitermos: Neoplasias da língua; Neoplasias bucais; Metástases linfáticas; Histologia.

ABSTRACT

The authors present a retrospective study of 54 patients with squamous cell carcinoma (SCC) of the fongue and floor of the mouth in stage II. The determination of clinical and hystological predictive factors of neck metastasis were the main proposal in T2 NO cases submitted to surgical approach at the Head and Neck Service of Heliópolis Hospital, Hosphel, from 1977 till 1993. The clinical aspects (location, size, alcohol, tabacco, sex, race, age, complain) and histological (macroscopy, injlammatory infiltration, differenciation degree, desmoplasia, mitoses number, vascular and perineural invasion) factors were analysed, using the K square statistical method with 2 x 2 tables and p less than 0.05. Concerning the outcomes for neck nodes metastases, 35.2% were positive coincident, 24.2% false negatives and 52.3% false positives. As conclusion, the main question of this paper were not obtained, due to the impossibility to determine the relation of predictive factors and natural history of the neoplasias of tongue and floor of the mouth.

Key words: Tongue neoplasms; Mouth neoplasms; Node metastasis; Histology.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

1. Kremen AJ. Surgical management of cancer of the tongue. Surg Clin North Am 1967;47:1.125-9.

2. Spiro RH, Strong EW. Surgical treatment of cancer of the tongue. Surg Clin North Am 1974;54(4):759-65.

3. Anzai Y, Blackwell KE, Hirschowitz SL, et al. initial clinical experience with dextran- coated superparamagnetic iron oxid for detection of lymph node metastases in patients with head and neck cancer. Radiology 1994; 192:709-15.

4. Molinari R, Grandi. Management of NO neck around the world. In: lnternational Conference on Head and Neck Cancer 4, Toronto, 1996; Proceedings Toronto, 1996.

5. Spiro RH, Spiro JD, Strong EW. Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth. Head Neck Surg 1986; 9:27-33.

6. Spiro JD, Spiro RH, Shah JP, et al. Critical assessment of supraomohyoid neck dissection. Am J Surg 1988;156:286-9.

7. Ho CM, Lam KH, Wei WUI, et al. Occult lymph node metastasis in small oral tongue cancers. Head & Neck 1992;14:359-63.

8. Jesse RH, Barkley Jr. HT, Lindberg RD, et al. Cancer of the oral cavity: is elective neck dissection and beneficial? Am J Surg 1970; 120:505-8.

9. Jesse RH, Lindberg RD. Evolution of clinically negative neck: squamous cell carcinoma of oral cavity and faucial arch. JAMA 1971;217(4):453.

10. Vandenbrouck C, Sancho-Garnier H, Chassagne D, et al. Elective versus therapy radical neck dissection in epidermoid carcinoma of the oral cavity. Cancer 1980;46:386-90.

11. Umeda M, Yokoo S, Take Y, et al. Lymph node metastasis in squamous cell carcinoma of the oral cavity: correlation between histologic features and the prevalence of metastasis. Head & Neck 1992;14: 263-72.

12. Fava AS, Rapoport A, Carvalho MB, et al. Modelo matemático de risco de metástase do carcinoma epidermóide de língua e soalho bucal. Rev Col Bras Cir 1995;22(4): 175-82.

13. Fava AS, Carvalho M. Conduta no pescoço NO. In: Brandão LG, Ferraz AR. Cirurgia de Cabeça e Pescoço. São Paulo: Livraria Rocca, 1989; 45-8.

14. Shah JP. Invited commentary. World J Surg 1990; 14:609. [Letter}

15. McGavran MH, Bauer WC, Ogura JH. The incidence of cervical lymph Rode metastases from epidermoid carcinoma of the larynx and their relationship to certain characteristics of the primary tumor: a study based on the clinical and pathological findings for 96 patients treated by primary en bloc laryngectomy and radical neck dissection. Cancer 1961;14:55-66.

16. Mendelson BC, Woods JE, Beahrs OH. Neck dissection in the treatment of carcinoma of the anterior two-thirds of the tongue. Surg Gynecol Obstet 1976;143:75-80.

17. Farr GH, Egell RA, Spiro RH, et al. Epidermoid carcinoma confined to the oral tongue: are there histologic findings of predictive value? Lab lnvest 1978;38:344.

18. Crissman JD, Liu WY, Gluckman JL, et al. Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx. Cancer 1984;54:2.995-3.00 I.

19. Goepfert H, Dichtel WJ, Medina JE, et al. Perineural invasion in squamous cell skin carcinoma of the head and neck. Am J Surg 1984; 148:542-7.

20. Rasgon BM, Cruz RM, Hilsinger Jr. RL, et al. Relation of lymph node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review. Laryngoscope 1989;99:1.103-IQ.

21. Close LG, Bums DK, Reich J, et al. Microvascular invasion in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Sur 1987;113:1.191-5.

22. Fakih AR, Rao RS, Borges AM, et al. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989; 158:309-13.

23. Hemmer J, Shon E, Kreidler J, et al. Prognostic implications of DNA ploidy in squarnous cell carcinomas of the tongue assessed by flow cytometry. J Cancer Res Clin Oncol 1990;116:83-6.

24. Briggs RJS, Pienta KJ, Kruban RH, et al. Nuclear morphometry for prediction of metastatic potential in early squamous cell carcinoma of the floor of the mouth. Arch Otolaryngol Head Neck Surg 1992;118:531-3.

25. Spafford MF, Koeppe J, Pan Z, et al. Correlation of tumor markers p53, bcl-2, CD-34, CD-44-H, CD44v6, and Ki-67 with survival and metastasis in laryngeal squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1996;122:627-3t.

Recebido em 18/3/97

Aceito para publicação em 28/7/97

Trabalho desenvolvido no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis.

1. Kremen AJ. Surgical management of cancer of the tongue. Surg Clin North Am 1967;47:1.125-9.
2. Spiro RH, Strong EW. Surgical treatment of cancer of the tongue. Surg Clin North Am 1974;54(4):759-65.
3. Anzai Y, Blackwell KE, Hirschowitz SL, et al. initial clinical experience with dextran- coated superparamagnetic iron oxid for detection of lymph node metastases in patients with head and neck cancer. Radiology 1994; 192:709-15.
4. Molinari R, Grandi. Management of NO neck around the world. In: lnternational Conference on Head and Neck Cancer 4, Toronto, 1996; Proceedings Toronto, 1996.
5. Spiro RH, Spiro JD, Strong EW. Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth. Head Neck Surg 1986; 9:27-33.
6. Spiro JD, Spiro RH, Shah JP, et al. Critical assessment of supraomohyoid neck dissection. Am J Surg 1988;156:286-9.
7. Ho CM, Lam KH, Wei WUI, et al. Occult lymph node metastasis in small oral tongue cancers. Head & Neck 1992;14:359-63.
8. Jesse RH, Barkley Jr. HT, Lindberg RD, et al. Cancer of the oral cavity: is elective neck dissection and beneficial? Am J Surg 1970; 120:505-8.
9. Jesse RH, Lindberg RD. Evolution of clinically negative neck: squamous cell carcinoma of oral cavity and faucial arch. JAMA 1971;217(4):453.
10. Vandenbrouck C, Sancho-Garnier H, Chassagne D, et al. Elective versus therapy radical neck dissection in epidermoid carcinoma of the oral cavity. Cancer 1980;46:386-90.
11. Umeda M, Yokoo S, Take Y, et al. Lymph node metastasis in squamous cell carcinoma of the oral cavity: correlation between histologic features and the prevalence of metastasis. Head & Neck 1992;14: 263-72.
12. Fava AS, Rapoport A, Carvalho MB, et al. Modelo matemático de risco de metástase do carcinoma epidermóide de língua e soalho bucal. Rev Col Bras Cir 1995;22(4): 175-82.
13. Fava AS, Carvalho M. Conduta no pescoço NO. In: Brandão LG, Ferraz AR. Cirurgia de Cabeça e Pescoço. São Paulo: Livraria Rocca, 1989; 45-8.
14. Shah JP. Invited commentary. World J Surg 1990; 14:609. [Letter}
15. McGavran MH, Bauer WC, Ogura JH. The incidence of cervical lymph Rode metastases from epidermoid carcinoma of the larynx and their relationship to certain characteristics of the primary tumor: a study based on the clinical and pathological findings for 96 patients treated by primary en bloc laryngectomy and radical neck dissection. Cancer 1961;14:55-66.
16. Mendelson BC, Woods JE, Beahrs OH. Neck dissection in the treatment of carcinoma of the anterior two-thirds of the tongue. Surg Gynecol Obstet 1976;143:75-80.
17. Farr GH, Egell RA, Spiro RH, et al. Epidermoid carcinoma confined to the oral tongue: are there histologic findings of predictive value? Lab lnvest 1978;38:344.
18. Crissman JD, Liu WY, Gluckman JL, et al. Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx. Cancer 1984;54:2.995-3.00 I.
19. Goepfert H, Dichtel WJ, Medina JE, et al. Perineural invasion in squamous cell skin carcinoma of the head and neck. Am J Surg 1984; 148:542-7.
20. Rasgon BM, Cruz RM, Hilsinger Jr. RL, et al. Relation of lymph node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review. Laryngoscope 1989;99:1.103-IQ.
21. Close LG, Bums DK, Reich J, et al. Microvascular invasion in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Sur 1987;113:1.191-5.
22. Fakih AR, Rao RS, Borges AM, et al. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989; 158:309-13.
23. Hemmer J, Shon E, Kreidler J, et al. Prognostic implications of DNA ploidy in squarnous cell carcinomas of the tongue assessed by flow cytometry. J Cancer Res Clin Oncol 1990;116:83-6.
24. Briggs RJS, Pienta KJ, Kruban RH, et al. Nuclear morphometry for prediction of metastatic potential in early squamous cell carcinoma of the floor of the mouth. Arch Otolaryngol Head Neck Surg 1992;118:531-3.
25. Spafford MF, Koeppe J, Pan Z, et al. Correlation of tumor markers p53, bcl-2, CD-34, CD-44-H, CD44v6, and Ki-67 with survival and metastasis in laryngeal squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1996;122:627-3t.

Endereço para correspondência:

Prof. Abrão Rapoport

Praça Amadeu Amaral, 47, cj. 82

01327-010 - São Paulo - SP

Datas de Publicação

Publicação nesta coleção
27 Jul 2010
Data do Fascículo
Fev 1998

Histórico

Recebido
18 Mar 1997
Aceito
28 Jul 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Kremen AJ. Surgical management of cancer of the tongue. Surg Clin North Am 1967;47:1.125-9.

[2] 2. Spiro RH, Strong EW. Surgical treatment of cancer of the tongue. Surg Clin North Am 1974;54(4):759-65.

[3] 3. Anzai Y, Blackwell KE, Hirschowitz SL, et al. initial clinical experience with dextran- coated superparamagnetic iron oxid for detection of lymph node metastases in patients with head and neck cancer. Radiology 1994; 192:709-15.

[4] 4. Molinari R, Grandi. Management of NO neck around the world. In: lnternational Conference on Head and Neck Cancer 4, Toronto, 1996; Proceedings Toronto, 1996.

[5] 5. Spiro RH, Spiro JD, Strong EW. Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth. Head Neck Surg 1986; 9:27-33.

[6] 6. Spiro JD, Spiro RH, Shah JP, et al. Critical assessment of supraomohyoid neck dissection. Am J Surg 1988;156:286-9.

[7] 7. Ho CM, Lam KH, Wei WUI, et al. Occult lymph node metastasis in small oral tongue cancers. Head & Neck 1992;14:359-63.

[8] 8. Jesse RH, Barkley Jr. HT, Lindberg RD, et al. Cancer of the oral cavity: is elective neck dissection and beneficial? Am J Surg 1970; 120:505-8.

[9] 9. Jesse RH, Lindberg RD. Evolution of clinically negative neck: squamous cell carcinoma of oral cavity and faucial arch. JAMA 1971;217(4):453.

[10] 10. Vandenbrouck C, Sancho-Garnier H, Chassagne D, et al. Elective versus therapy radical neck dissection in epidermoid carcinoma of the oral cavity. Cancer 1980;46:386-90.

[11] 11. Umeda M, Yokoo S, Take Y, et al. Lymph node metastasis in squamous cell carcinoma of the oral cavity: correlation between histologic features and the prevalence of metastasis. Head & Neck 1992;14: 263-72.

[12] 12. Fava AS, Rapoport A, Carvalho MB, et al. Modelo matemático de risco de metástase do carcinoma epidermóide de língua e soalho bucal. Rev Col Bras Cir 1995;22(4): 175-82.

[13] 13. Fava AS, Carvalho M. Conduta no pescoço NO. In: Brandão LG, Ferraz AR. Cirurgia de Cabeça e Pescoço. São Paulo: Livraria Rocca, 1989; 45-8.

[14] 14. Shah JP. Invited commentary. World J Surg 1990; 14:609. [Letter}

[15] 15. McGavran MH, Bauer WC, Ogura JH. The incidence of cervical lymph Rode metastases from epidermoid carcinoma of the larynx and their relationship to certain characteristics of the primary tumor: a study based on the clinical and pathological findings for 96 patients treated by primary en bloc laryngectomy and radical neck dissection. Cancer 1961;14:55-66.

[16] 16. Mendelson BC, Woods JE, Beahrs OH. Neck dissection in the treatment of carcinoma of the anterior two-thirds of the tongue. Surg Gynecol Obstet 1976;143:75-80.

[17] 17. Farr GH, Egell RA, Spiro RH, et al. Epidermoid carcinoma confined to the oral tongue: are there histologic findings of predictive value? Lab lnvest 1978;38:344.

[18] 18. Crissman JD, Liu WY, Gluckman JL, et al. Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx. Cancer 1984;54:2.995-3.00 I.

[19] 19. Goepfert H, Dichtel WJ, Medina JE, et al. Perineural invasion in squamous cell skin carcinoma of the head and neck. Am J Surg 1984; 148:542-7.

[20] 20. Rasgon BM, Cruz RM, Hilsinger Jr. RL, et al. Relation of lymph node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review. Laryngoscope 1989;99:1.103-IQ.

[21] 21. Close LG, Bums DK, Reich J, et al. Microvascular invasion in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Sur 1987;113:1.191-5.

[22] 22. Fakih AR, Rao RS, Borges AM, et al. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989; 158:309-13.

[23] 23. Hemmer J, Shon E, Kreidler J, et al. Prognostic implications of DNA ploidy in squarnous cell carcinomas of the tongue assessed by flow cytometry. J Cancer Res Clin Oncol 1990;116:83-6.

[24] 24. Briggs RJS, Pienta KJ, Kruban RH, et al. Nuclear morphometry for prediction of metastatic potential in early squamous cell carcinoma of the floor of the mouth. Arch Otolaryngol Head Neck Surg 1992;118:531-3.

[25] 25. Spafford MF, Koeppe J, Pan Z, et al. Correlation of tumor markers p53, bcl-2, CD-34, CD-44-H, CD44v6, and Ki-67 with survival and metastasis in laryngeal squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1996;122:627-3t.