Associação entre os aspectos clínicos e patológicos à dor e qualidade de vida dos pacientes com carcinoma de células escamosas da cavidade oral

Abstract

Squamous cell carcinoma of the buccal mucosa and oropharynx shows a high prevalence and mortality rate, and pain is a critical clinical symptom. The aims were to relate clinical and histopathological aspects to orofacial pain and life quality in 37 patients with a prior diagnosis of oral squamous cell carcinoma in mouth or oropharynx. Questionnaires for clinical data, pain, and life quality were applied. Histopathological data were also collected from the patient's medical records and correlated with the analysis of slides of patients' biopsies stained with hematoxylin and eosin. Intra/peritumoral tumor-infiltrating lymphocytes density was assessment. In addition, the prognostic value of inflammatory cells presents in blood counts collected before surgery was investigated. The neutrophil/lymphocyte ratios, platelets/lymphocytes, and monocytes/lymphocytes were used to establish the systemic inflammation index. These data were associated with clinical variables, such as tumor location, size, histopathological grade, lymph node involvement, metastasis, and pre- and post-treatment staging. Data were analyzed by test T, Mann-Whitney, or Fisher test. Survival analyses were performed using the Kaplan-Meier test with a 95% confidence interval. All analyses were performed using IBM SPSS software, version 25, with a significance level of 5%. Pain was present in 100% of the population, with the tongue being the most prevalent location. The pain intensity was moderate, with the presence of neuropathic components. Pain intensity is associated with tumor location in mouth, greater difficulty chewing and dysphonia – especially deep, diffuse, continuous pain and with neuropathies – and worse life quality components. Individuals with nodular or ulcerative/infiltrative lesions had pain that was more like stabbing, needling, snaking, or lacerating. Individuals with nodular or ulcerative/infiltrative lesions had pain that was more like stabbing, needling, snaking, or lacerating. Patients with a high density of tumor-infiltrating lymphocytes were more likely to be in more advanced stages of the disease, and localized pain was associated with a low density of tumor-infiltrating lymphocytes. There was no association between tumor-infiltrating lymphocytes and necrosis, hemorrhage, or perineural or lymph vascular invasion. Patients segregated with a high neutrophil/lymphocyte ratios value were associated with tumor location in oropharynx, lymph node involvement (N1), and an advanced initial staging (IV) that corresponded to the worst clinical outcome. Finally, associations between systemic inflammation index and clinical variables showed no association. The findings contribute to the understanding of pain, life quality, and clinical and histopathological characteristics of the tumor, with future repercussions on the prognosis and treatment of patients with squamous cell carcinoma.