Pathology Graduate Program, Fluminense Federal University, Niterói, Brazil.
J Oral Pathol Med. 2012 Jan;41(1):34-9. doi: 10.1111/j.1600-0714.2011.01068.x. Epub 2011 Sep 8.
The TNM system has been used for decades in an attempt to predict clinical behavior and appropriate therapy for oral squamous cell carcinomas. Histopathologic classifications can be useful as an additional predictive tool. The purpose of this study was to apply four grading systems (Multiparameter Grading System, Malignancy Grading of the Deep Invasive Margins, World Health Organization grading system, and Histologic Risk Assessment) to oral squamous cell carncinomas and evaluate each system based on clinicopathologic parameters and patient survival.
The files of 53 patients diagnosed with primary oral squamous cell carcinoma at the Brazilian National Cancer Institute were evaluated. All hematoxylin and eosin-stained slides were reviewed to confirm the original diagnosis and to determine histopathologic grading. Clinicopathologic information was obtained from medical records and tumor registries. Statistical analysis was performed using Fisher's exact test or the chi-square test, the Kaplan-Meier method, and the log-rank test.
The Multiparameter Grading System was statistically associated with pathologic staging (P = 0.02) and lymph node involvement (P = 0.0009). Differences in overall 5-year survival were significant for Histologic Risk Assessment (P = 0.015), pathologic staging (P = 0.001), lymph node status (P < 0.0001), and recurrence (P = 0.0001). Differences in cancer-specific 5-year survival were significant for Histologic Risk Assessment (P = 0.029), pathologic staging (P = 0.002), lymph node involvement (P < 0.0001), and recurrence (P < 0.0001). Poorly differentiated tumors were associated with the worst disease-free survival (P = 0.031) and recurrence (P = 0.043).
Of the grading systems evaluated, Histologic Risk Assessment demonstrated the best results for survival prediction in oral squamous cell carcinoma.
TNM 系统已使用数十年，试图预测口腔鳞状细胞癌的临床行为和适当的治疗方法。组织病理学分类可用作附加的预测工具。本研究的目的是将四种分级系统（多参数分级系统、深部浸润边缘恶性分级、世界卫生组织分级系统和组织学风险评估）应用于口腔鳞状细胞癌，并根据临床病理参数和患者生存情况评估每种系统。
评估了在巴西国家癌症研究所诊断为原发性口腔鳞状细胞癌的 53 名患者的档案。所有苏木精和伊红染色切片均进行了复查，以确认原始诊断并确定组织病理学分级。临床病理信息从病历和肿瘤登记处获得。Fisher 确切检验或卡方检验、Kaplan-Meier 方法和对数秩检验用于统计分析。
多参数分级系统与病理分期（P=0.02）和淋巴结受累（P=0.0009）具有统计学相关性。组织学风险评估（P=0.015）、病理分期（P=0.001）、淋巴结状态（P<0.0001）和复发（P=0.0001）的总 5 年生存率差异有统计学意义。组织学风险评估（P=0.029）、病理分期（P=0.002）、淋巴结受累（P<0.0001）和复发（P<0.0001）的癌症特异性 5 年生存率差异有统计学意义。低分化肿瘤与无病生存率最差（P=0.031）和复发（P=0.043）相关。
在所评估的分级系统中，组织学风险评估在预测口腔鳞状细胞癌的生存方面显示出最佳结果。
