Oral Sküamoz Hücreli Karsinom Evreleme Bulgularının Retrospektif Olarak Değerlendirilmesi

Abstract

Amaç: Oral kavitede görülen malign tümörlerin %85-95’i, oral mukozayı döşeyen skuamöz epitelden köken almaktadır. Oral skuamöz hücreli karsinom (OSHK) genellikle ileri evrelerde teşhis edildiği için çeşitli komplikasyonlara ve yüksek mortalite oranına sahip olan bir kanser türüdür. TNM evrelendirmesi malign tümörlerin prognozunu değerlendirmek amacıyla en sık kullanılan sistemlerden biridir. Bu çalışmada histopatolojik olarak OSHK tanısı konulmuş olguların TNM evrelenmesi için gerekli bulgular retrospektif olarak değerlendirilmiştir. Gereç ve Yöntemler: 2018-2023 yılları arasında Kocaeli Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalında incelenmiş ve OSHK tanısı almış olgular retrospektif olarak değerlendirilmiştir. OSHK olgularının TNM evrelenmesi için lezyon boyutu, tümör invazyon derinliği, metastaz varlığı, lenf nodu tutulumu ve boyutu değerlendirilmiştir. Ayrıca hastaların demografik bilgileri, tümör lokalizasyonu ve diferansiyasyon derecesinin TNM evrelenmesiyle ilişkisi değerlendirilmiştir. Bulgular: Bu çalışmada 15 erkek ve 18 kadın olmak üzere 33 OSHK olgusu retrospektif olarak değerlendirilmiştir. İyi diferansiyasyon gözlenen 16 olguda tümör boyutu ortalama 2,4 cm, orta derece diferansiyasyon gözlenen 17 olguda ise 3,3 cm olarak bulunmuştur. İyi diferansiye olgular en sık dil tutulumu gösterirken, orta derece diferansiye olgularda dil dışında gingiva, retromolar bölge ve bukkal mukozada da tutulum saptanmıştır. Orta derece diferansiye 4 olguda lenf nodu tutulumu mevcuttur. Hiçbir olguda metastaz saptanmamıştır. Sonuçlar: Oral kavitedeki tümörlerin boyutu 2 cm’den küçük olduğunda (T1) BT veya MR gibi görüntüleme yöntemleriyle tespit edilemez. Boyutu 2 cm’den büyük olduğunda (T2 ve üstü) çevre dokulara invazyon ve metastaz yapma olasılığı artar. Bu yüzden diş hekimleri prekanseröz lezyonları tanımalı ve özellikle ileri yaşlardaki hastalarda ülsere/eroziv lezyonlara dikkat etmelidir. Anahtar Kelimeler: Skuamöz hücreli karsinom, Tümör evrelemesi, TNM

Keywords

• Skuamöz hücreli karsinom
• Tümör evrelemesi
• TNM

Retrospective Evaluation of Oral Squamous Cell Carcinoma Staging Outcomes

Abstract

Objectives Between 85-95% of malignant tumors in the oral cavity originate from squamous epithelium lining the oral mucosa. Oral squamous cell carcinoma (OSCC) is a type of cancer with various complications and a high mortality rate because it is usually diagnosed at advanced stages. TNM most commonly used systems to evaluate the prognosis of malignant tumors. In this study, the findings required for TNM staging of patients with histopathologically diagnosed OSCC were evaluated retrospectively. Materials-Methods We retrospectively evaluated the patients who were examined in Kocaeli University Faculty of Medicine, Department of Pathology between 2018 and 2023 and diagnosed with OSCC. For TNM staging of OSCC cases, lesion size, depth of tumor invasion, presence of metastasis, lymph node involvement and size were evaluated. In addition, demographic data, tumor localization and differentiation grade were evaluated in relation to TNM staging. Results In this study, 33 OSCC cases were retrospectively evaluated. Mean tumor size was 2.4 cm in 16 cases with good-differentiation and 3.3 cm in 17 cases with moderate-differentiation. While good-differentiated cases most commonly involved the tongue, moderately differentiated cases involved the gingiva. Lymph node involvement was present in 4 moderately differentiated cases. Metastasis was not detected in any case. Conclusion When the size of tumors in the oral cavity is less than 2 cm (T1), they cannot be detected by CT or MR. When the size is larger than 2 cm (T2 and above), the possibility of invasion and metastasis to surrounding tissues increases. Therefore, dentists should pay attention to ulcerated/erosive lesions. Keywords Squamous cell carcinoma, Tumor staging, TNM

Keywords

• Squamous cell carcinoma
• Tumor staging
• TNM

References

1. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209–49.
2. 2. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009;45:309–16.
3. 3. Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primer 2020;6:92.
4. 4. Tekkeşi̇n MS, Ersan N, Aksakallı N, Olgaç V, Alatli C. Oral skuamöz hücreli karsinom: 147 vakanın retrospektif çalışması. Gazi Üniversitesi Diş Hekim Fakültesi Derg 2012;29:93–8.
5. 5. Taş A, Yilmaz S, Si̇Ndel A. Oral Skuamoz Hücreli Karsinom – 3 Olgu Sunumu. Osman J Med 2020;42:142–7.
6. 6. Lydiatt WM, Patel SG, O’Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, et al. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin 2017;67:122–37.
7. 7. Huang SH, O’Sullivan B. Overview of the 8th Edition TNM Classification for Head and Neck Cancer. Curr Treat Options Oncol 2017;18:40.
8. 8. Lin N-C, Hsu J-T, Tsai K-Y. Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study. PLoS ONE 2020;15:e0238103.

9. 9. Gao W, Guo C-B. Factors related to delay in diagnosis of oral squamous cell carcinoma. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 2009;67:1015–20.
10. 10. Gómez I, Seoane J, Varela-Centelles P, Diz P, Takkouche B. Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis. Eur J Oral Sci 2009;117:541–6.
11. 11. Mauceri R, Bazzano M, Coppini M, Tozzo P, Panzarella V, Campisi G. Diagnostic delay of oral squamous cell carcinoma and the fear of diagnosis: A scoping review. Front Psychol 2022;13:1009080.
12. 12. Chinn SB, Myers JN. Oral Cavity Carcinoma: Current Management, Controversies, and Future Directions. J Clin Oncol Off J Am Soc Clin Oncol 2015;33:3269–76.
13. 13. International Consortium for Outcome Research (ICOR) in Head and Neck Cancer, Ebrahimi A, Gil Z, Amit M, Yen T-C, Liao C-T, et al. Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study. JAMA Otolaryngol—Head Neck Surg 2014;140:1138–48.
14. 14. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more ‘personalized’ approach to cancer staging. CA Cancer J Clin 2017;67:93–9.
15. 15. Pollaers K, Hinton-Bayre A, Friedland PL, Farah CS. AJCC 8th Edition oral cavity squamous cell carcinoma staging - Is it an improvement on the AJCC 7th Edition? Oral Oncol 2018;82:23–8.
16. 16. Kowalski LP, Köhler HF. Relevant changes in the AJCC 8th edition staging manual for oral cavity cancer and future implications. Chin Clin Oncol 2019;8:S18.
17. 17. Matos LL, Dedivitis RA, Kulcsar MAV, de Mello ES, Alves VAF, Cernea CR. External validation of the AJCC Cancer Staging Manual, 8th edition, in an independent cohort of oral cancer patients. Oral Oncol 2017;71:47–53.
18. 18. Kano S, Sakashita T, Tsushima N, Mizumachi T, Nakazono A, Suzuki T, et al. Validation of the 8th edition of the AJCC/UICC TNM staging system for tongue squamous cell carcinoma. Int J Clin Oncol 2018;23:844–50.
19. 19. Murthy S, Low T-HH, Subramaniam N, Balasubramanian D, Sivakumaran V, Anand A, et al. Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma. J Surg Oncol 2019;119:449–54.
20. 20. van Lanschot CGF, Klazen YP, de Ridder MAJ, Mast H, Ten Hove I, Hardillo JA, et al. Depth of invasion in early stage oral cavity squamous cell carcinoma: The optimal cut-off value for elective neck dissection. Oral Oncol 2020;111:104940.
21. 21. Kerdpon D, Sriplung H. Factors related to advanced stage oral squamous cell carcinoma in southern Thailand. Oral Oncol 2001;37:216–21.
22. 22. Onizawa K, Nishihara K, Yamagata K, Yusa H, Yanagawa T, Yoshida H. Factors associated with diagnostic delay of oral squamous cell carcinoma. Oral Oncol 2003;39:781–8.
23. 23. Morelatto RA, Herrera MC, Fernández EN, Corball AG, López de Blanc SA. Diagnostic delay of oral squamous cell carcinoma in two diagnosis centers in Córdoba Argentina. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol 2007;36:405–8.
24. 24. Andisheh-Tadbir A, Mehrabani D, Heydari ST. Epidemiology of squamous cell carcinoma of the oral cavity in Iran. J Craniofac Surg 2008;19:1699–702.
25. 25. Nemes JA, Redl P, Boda R, Kiss C, Márton IJ. Oral cancer report from Northeastern Hungary. Pathol Oncol Res POR 2008;14:85–92.
26. 26. Lo W-L, Kao S-Y, Chi L-Y, Wong Y-K, Chang RC-S. Outcomes of oral squamous cell carcinoma in Taiwan after surgical therapy: factors affecting survival. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 2003;61:751–8.
27. 27. Rodrigues VC, Moss SM, Tuomainen H. Oral cancer in the UK: to screen or not to screen. Oral Oncol 1998;34:454–65.
28. 28. Silverman S. Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc 1939 2001;132 Suppl:7S-11S.
29. 29. Gaitán-Cepeda L-A, Peniche-Becerra A-G, Quezada-Rivera D. Trends in frequency and prevalence of oral cancer and oral squamous cell carcinoma in Mexicans. A 20 years retrospective study. Med Oral Patol Oral Cirugia Bucal 2011;16:e1-5.