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13.
Combined therapy for oral cavity and oropharyngeal squamous cell carcinoma : depth of invasion as prognostic factor
Čizmarevič, Bogdan ...
Background. The aim of the study was to emphasize the importance of surgical management of squamous cell carcinoma (SCC) in the head and neck 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 determining the occurrence of the neck metastases whereas the N status determines the survival.
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