Erken evre oral kavite kanserlerinde boyun metastazının ön belirteçleri

Yıl 2015, Cilt: 5 Sayı: 2, 82 - 86, 14.01.2016

Süha Ertuğrul Gökşen Ertuğrul Abdülkadir İmre Ercan Pınar Çağlar Çallı Aylin Orgen Çallı Semih Öncel

Öz

Amaç: Erken evre oral kavite kanserlerinde klinik ve histopatolojik parametrelerin boyun metastazına olan etkilerini saptamak.

Yöntem: Erken evre oral kavite karsinomu nedeniyle İzmir Atatürk Eğitim ve Araştırma Hastanesinde Haziran 2001 ile Haziran 2010 tarihleri arasında primer cerrahi rezeksiyon ve eş zamanlı boyun diseksiyonu yapılan 92 hastanın medikal kayıtları retrospektif olarak incelendi. Klinik ve histopatolojik parametrelerin boyun metastazı ile olan ilişkileri değerlendirildi. Histolojik verilerden, tümör genişliği ve tümör derinliğinin ölçümü operatif dokunun histolojik kesitleri ile elde edildi. Optik mikrometre ile horizontal planda maksimum genişlik ve vertikal planda maksimum derinlik ölçüldü ve maksimum derinlik tümör kalınlığı olarak kayıt edildi.

Bulgular: Oral kavite kanserlerinde, tümör lokalizasyonu, T evresi, diferansiyasyon derecesi, tümör kalınlığı, perinöral invazyon, vasküler invazyon ve perilenfatik invazyon ile boyun metastazı arasındaki ilişki istatiksel olarak anlamlı bulundu (p<0.05). Boyun metastazı için kritik tümör kalınlığı değeri 5.6 mm olarak bulundu.

Sonuç: Bu çalışmanın sonuçlarına göre, oral kavite kanserlerinde boyun metastazı gelişiminde 5.6 mm tümör kalınlığı kritik değerdir. Bu değeri aşan hastalarda boyun metastazı riski belirgin olarak artmaktadır. Gizli metastaz riski yüksek olan oral kavite kanserlerinde tümör kalınlığı preoperatif ya da peroperatif olarak saptanabilir ve kritik değerleri aştığında elektif boyun diseksiyonuna karar verilebilir.

Anahtar sözcükler: Boyun metastazı, oral kavite kanseri, tümör kalınlığı.

Anahtar Kelimeler

Boyun metastazı, oral kavite kanseri, tümör kalınlığı

Predictors of neck metastasis in early stage oral cavity cancer

Öz

Objective: To identify the effects of clinical and histopathological
parameters on neck metastasis in early-stage oral cavity cancers.
Methods: The medical records of 92 patients who underwent primary
surgical resection and concurrent neck dissection due to early-stage oral
cavity squamous cell cancer at ‹zmir Atatürk Training and Research
Hospital between June 2001 and June 2010 were retrospectively
reviewed. The associations of clinical and histological parameters with
neck metastasis were assessed. Based on the histological data, the histological sections of the operative tissue were obtained via the measurement of tumor width and tumor depth. Using an optical micrometer,
the maximum width at the horizontal plane and the maximum depth at
the vertical plane were measured and the maximum depth was recorded as tumor thickness.
Results: The association between neck metastasis and tumor localization,
T stage, degree of differentiation, tumor thickness, perineural invasion,
vascular invasion and perilymphatic invasion in early-stage oral cavity cancers was found statistically significant (p<0.05). The value of critical tumor
thickness for the neck metastasis was found to be 5.6 mm.
Conclusion: On the basis of our results, a tumor thickness of 5.6 mm is
the critical value for the development of neck metastasis in oral cavity
cancers. The neck metastasis risk showed a significant increase in cases
where the tumor thickness exceeded this threshold value. In oral cavity cancers with a high risk of occult metastasis, the tumor thickness may
be identified pre-operatively or intra-operatively and, a decision can be
taken to perform neck dissection when they exceed critical values. 

Anahtar Kelimeler

Neck metastasis, oral cavity cancer, tumor thickness

Kaynakça

• Pericot J, Escriba JM, Valdes A, et al. Survival evaluation of treat- ment modality in squamous cell carcinoma of the oral cavity and oropharynx. J Craniomaxillofac Surg 2000;28:49–55.
• Chen YK, Huang HC, Lin LM, et al. Primary oral squamous cell carcinoma: an analysis of 703 cases in southern Taiwan. Oral Oncol 1999;35:173–9.
• Lindelov B, Kirkegaard J, Hansen HS. Squamous cell carcinoma of the oral cavity. An unselected material from a 5 year period. Acta Oncol 1990;29:1011–5.
• Larsen SR, Johansen J, Sİrensen JA, Krogdahl A. The prognostic significance of histological features in oral squamous cell carcino- ma. J Oral Pathol Med 2009;38:657–62.
• Rodolico V, Barresi E, Di Lorenzo R, et al. Lymph node metasta- sis in lower lip squamous cell carcinoma in relation to tumour size, histologic variables and p27Kip1 protein expression. Oral Oncol 2004;40:92–8.
• Rahima B, Shingaki S, Nagata M, Saito C. Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:423–31.
• Mohit-Tabatabai MA, Sobel HJ, Rush BF, Mashberg A. Relation of thickness of floor of mouth stage I and II cancers to regional metastasis. Am J Surg 1986;152:351–3.
• Moore C, Kuhns JG, Greenberg RA. Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg 1986;121:1410–4.
• Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue andfloor of hemouth. Am J Surg 1986;152: 345–50.
• Shingaki S, Suzuki I, Nakajima T, Kawasaki T. Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas. Oral Surg Oral Med Oral Pathol 1988;66:683–8.
• Rasgon BM, Cruz RM, Hilsinger RL Jr, Sawicki JE. Relation of lymph-node metastasis to histopathologic appearance in oral cav- ity and oropharyngeal carcinoma: a case series and literature review. Laryngoscope 1989;99:1103–10.
• Martinez-Gimeno C, Rodriguez EM, Vila CN, Varela CL. Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metasta- sis. Laryngoscope 1995;105:728–33.
• Yuen APW, Lam KY, Wei WI, et al. A comparison of the prog- nosis significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue car- cinoma. Am J Surg 2000;180:139–43.
• Po Wing Yuen A, Lam KY, Lam LK, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma – a comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic fea- tures. Head Neck 2002;24:513–20.
• O’Brien CJ, Lauer CS, Fredricks S, et al. Tumor thickness influ- ences prognosis of T1 and T2 oral cavity cancer – but what thick- ness? Head Neck 2003;25:937–45.
• Veness MJ, Morgan GJ, Sathiyaseelan Y, Gebski V. Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients? ANZ J Surg 2005;75: 101–5.
• Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 2002;24:731–6.
• Fakih AR, Rao RS, Borges AM, Patel AR. Elective versus thera- peutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989;158:309–13.
• Asakage T, Yokose T, Mukai K, et al. Tumor thickness predicts cervical metastasis in patients with stage I/II carcinoma of the tongue. Cancer 1998;82:1443–8.
• Al-Rajhi N, Khafaga Y, El-Husseiny J, et al. Early stage carcino- ma of oral tongue: prognostic factors for local control and survival. Oral Oncol 2000;36:508–14.
• Nathanson A, Agren K, Biorklund A, et al. Evaluation of some prognostic factors in small squamous cell carcinomas of the mobile tongue: a multicenter study in Sweden. Head Neck 1989;11:387– 92.
• O-charoenrat P, Pillai G, Patel S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol 2003;39:386–90.
• Woolgar JA, Scott J. Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. Head Neck 1995;17:463–72.
• Suzuki M, Suzuki T, Asai M, et al. Clinicopathological factors related to cervical lymph node metastasis in a patient with carcino- ma of the oral floor. Acta Oto-Laryngol 2007;127:129–35.
• This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
• NC-ND3.0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
• tion in any medium, provided the original work is properly cited.
• Please cite this article as: Ertuğrul S, Ertuğrul G, İmre A, Pınar E, Çallı Ç, Orgen Çallı A, Öncel S. Predictors of neck metastasis in early stage oral
• cavity cancer. ENT Updates 2015;5(2):82–86.