Welkoborsky H J, Gluckman J L, Jacob R, Bernauer H, Mann W
Laryngorhinootologie. 1999 Mar;78(3):131-8. doi: 10.1055/s-2007-996845.
Conventional prognostic factors in squamous cell carcinomas are tumor stage, tumor size, evidence of lymph node metastases, extracapsular spread of lymph node metastases, and Broder's grading. Unfortunately these parameters are only of limited value in predicting the biological behavior and ultimately the prognosis of a particular tumor. The present study was conducted for determining objective prognostic factors based on tumor biologic examinations in patients with squamous cell carcinomas of the oral cavity. These parameters were compared to the conventional prognostic factors.
Operative specimens of fourty-two patients who underwent surgery for a squamous cell carcinoma of the oral cavity with clinical TNM stage T1N0M0 were examined. All tumors were radically excised with histologic clear margins, which were confirmed by serial sections. The examinations included morphologic multifactorial tumor front grading, quantitative DNA analysis, and immunohistochemical assessment of proliferation markers (i.e. proliferating cell nuclear antigen [PCNA] and MIB1) and of oncogene products (i.e. p53; nm23). Prognostic significance of particular parameters was evaluated by univariate and multivariate Cox regression models.
In clinical follow-up of 70 months on average, 6 patients developed local recurrences and 5 patients lymph node metastases. Three patients died of disease. Tumors which recurred had increased values for 2 c Deviation Index, 5 c Exceeding Rate along with high tumor front grading scores and proliferation scores. Using multivariate Cox regression analysis, parameters which were highly significant for prognosis were 5 c Exceeding Rate, tumor front grading score and PCNA score. None of the clinical parameters achieved statistical significance in the multivariate model. Tumors which recurred had also increased expression rates for p53 and nm23. Nevertheless this was statistically not significant.
Tumor biologic examinations provide important informations about the clinical aggressiveness and ultimately about the prognosis of a particular tumor. Tumors with aggressive behavior can already be identified during initial diagnosis, which has consequences for the therapeutic management of the patients.
鳞状细胞癌的传统预后因素包括肿瘤分期、肿瘤大小、淋巴结转移证据、淋巴结转移的包膜外扩散以及布罗德分级。不幸的是，这些参数在预测特定肿瘤的生物学行为及最终预后方面价值有限。本研究旨在基于口腔鳞状细胞癌患者的肿瘤生物学检查确定客观预后因素，并将这些参数与传统预后因素进行比较。
对42例临床TNM分期为T1N0M0的口腔鳞状细胞癌患者的手术标本进行检查。所有肿瘤均行根治性切除，切缘组织学检查阴性，并经连续切片证实。检查包括形态学多因素肿瘤前沿分级、定量DNA分析以及增殖标志物（即增殖细胞核抗原[PCNA]和MIB1）和癌基因产物（即p5３；nm23）的免疫组化评估。通过单因素和多因素Cox回归模型评估特定参数的预后意义。
平均70个月的临床随访中，6例患者出现局部复发，5例患者出现淋巴结转移。3例患者死于疾病。复发肿瘤的2c偏差指数、5c超出率值升高，同时肿瘤前沿分级评分和增殖评分较高。采用多因素Cox回归分析，对预后具有高度显著性的参数为5c超出率、肿瘤前沿分级评分和PCNA评分。在多因素模型中，所有临床参数均未达到统计学显著性。复发肿瘤的p53和nm23表达率也升高。然而，这在统计学上并不显著。
肿瘤生物学检查提供了有关特定肿瘤临床侵袭性及最终预后的重要信息。在初始诊断时即可识别具有侵袭性行为的肿瘤，这对患者的治疗管理具有重要意义。
