Características clínico-demográficas, indicadores histológicos e ALDH1 para previsão de metástase linfonodal em carcinoma de células escamosas de lábio, boca e orofaringe

Abstract

Clinical-demographic characteristics, histological indicators and ALDH1 for predicting lymph node metastasis in squamous cell carcinoma of the lip, mouth and oropharynx. Lymph node metastasis (LM) is considered the main negative prognostic factor in squamous cell carcinomas (SCC) of the lip, mouth, and oropharynx. Previous studies have reported possible prognostic and predictive factors for the occurrence of LM; however, most evaluated these factors in univariate analysis and were restricted to intraoral sites. Objectives: 1) To evaluate the predictive level of clinical-demographic characteristics and histological and immunohistochemical variables for the occurrence of LM in SCC; 2) To report the methodological difficulties in evaluating prognostic markers; 3) To evaluate the prognostic level of clinicopathological characteristics for overall survival; and 4) To evaluate the predictive level of depth of invasion in SCC of the lip and oropharynx. Methods: 1) A multicenter, retrospective, cross-sectional study of 82 SCC cases was conducted. Clinical-demographic data, including the occurrence of LM, were collected, and histological factors were evaluated in the entire sample. Univariate and multivariate logistic regressions were performed. 2) A narrative literature review described the methodological difficulties related to the histological markers evaluated in Stage 1. 3) Among the cases collected in the multicenter study, 77 had information on overall survival. In these cases, clinical and demographic data were collected and histological variables were evaluated. Kaplan-Meier curves and Cox regressions were performed. 4) Development of a systematic review, possibly with meta-analysis, evaluating the predictive and prognostic value of tumor invasion depth in SCC of the lip and oropharynx. Results: 1) Among the cases analyzed, 30 (36.6%) presented lymph node metastasis. In univariate logistic regression, seven factors were associated with the occurrence of LM; in the multivariate model, the variables anatomical location (mouth - OR 11.19 (95% CI 2.00-63.74) and oropharynx - OR 13.04 (95% CI 2.16-78.63)) and tumor size (2.1 to 4cm - OR 3.72 (95% CI 0.91-15.40) and >4cm - OR 13.93 (95% CI 2.82-68.90)) remained significant. 2) The incorporation of predictive and prognostic histological markers into the laboratory routine requires training, attention to the specificities of each marker and, in some cases, support for the immunohistochemical technique. 3) In univariate Cox regression, seven variables showed a statistically significant association with overall survival. However, only anatomical location (oropharynx HR 3.04 (95% CI 1.23-7.48)) and tumor size (>4 cm HR 3.94 (95% CI 1.57-8.87) remained significant in the multivariate analysis. 4) The systematic review identified 34 articles evaluating SCC of the lip and oropharynx, of which 28 reported a statistical association between depth of tumor invasion and at least one of the outcomes evaluated. Conclusion: In the sample evaluated, only anatomical location and tumor size were significant predictors of LM and prognostic factors in multivariate models. Investigating multiple prognostic markers in diagnostic practice may not be feasible. Therefore, simple, easily measured variables, such as lesion location and tumor size, have widespread applicability in cancer centers.