Baş boyun bölgesinin non melanotik malign deri tümörlerinin rekürrens ve metastaz kriterlerinin araştırılması
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Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Üniversitemize başvuran baş ve boyun bölgesinde yerleşim gösteren non-melanotik deri kanserli olgularda prognostik faktörlerin değerlendirilmesi, kanserin yerleşim yerine, prognostik faktörlere ve operasyonun ameliyathanede veya poliklinikte yapılmasına göre cerrahi sınırların yeterliliği, nüks ve metastaz sıklığının belirlenmesi amaçlanmıştır. YÖNTEM: 2009 ocak ve 2016 ocak tarihleri arasına hastanemiz plastik cerrahi kliniğine başvurmuş ve poliklinikte veya ameliyathanede opere olmuş primer non melanotik cilt kanseri (bazal hücreli karsinom ve skuamoz hücreli karsinom) tanılı hastalar çalışmaya dahil edildi. Bu hastaların üniversitemiz patoloji bölümü arşivindeki preparatları da tarandı. Hastalar patoloji preperatları, yaş, cinsiyet, tümör tipi, tümörün yeri, tümör büyüklüğü, cerrahi sınırlar, diferansiyasyon derecesi, inflamasyon derecesi, atipik mitoz, nörovaskuler tutulum, kas invazyonu, yapılan tedavi, lenf nodu tutulumu nüks ve metastaz açısından yeniden değerlendirildi. Daha sonra sonuçlarla istatiksel analiz yapıldı. BULGULAR: 178 (%59)' i erkek, 119 (%40,1)'i toplamda 297 hastadan hastaların %83,8' i 60 yaş üstü idi. Tümör cinsi açısından 230 adet (%77,4) BHK, 67 adet (%22,6) YEHK mevcuttu. BHK alt tip açısından en sık 119 adet (%51,7) nodüler varyant daha sona 75 adet (%32,6) infiltran varyant mevcuttu. Ortalama tümör çapı ise 1,52 cm idi. En yakın lateral sınır ortalaması BHK için 4,9 mm, YEHK için 2,8 mm olarak bulundu. Lateral sınır 27 hastada (%9,1) pozitifti. Taban sınır ortalaması ise 0,39 cm idi. Taban cerrahi sınır 14 hastada (%4,7) pozitifti. YEHK' da tümör en sık burun, ikinci ensık periorbital bölgede yerleştiği görüldü. BHK' da tümör en sık burun ikinci en sık olarak malar bölgede olduğu görüldü. Hastaların 33' ünde (%11,1) nörovasküler invazyon tespit edildi. Hastaların 227' sinde (76,4%) subkutan invazyon tespit edildi. Hastaların 84' ünde (%28,3) kas invazyonu tespit edildi. Tedavi şekli olarak en çok (%49,8) eksizyon ve fleple onarım yapılmıştı. 11 hastada metastaz mevcuttu, bunların hepsi de YEHK hastaları idi. 32 hastada (%10,8) nüks izlendi. BHK' da nüks oranı % 8,6, YEHK' da nüks oranı % 17,9 olarak bulundu BHK' da nüksün tümör alt tipi, diferansiyasyon, nörovasküler invazyon, takip süresi ile ilişkli olduğu bulundu. YEHK' da nüksün nörovasküler invazyon, ilk başvuru anında lenf 4 nodu tutulumu ile ilişkili olduğu bulundu. YEHK' da metastazın diferansiyasyon, nörovasküler invazyon, kas invazyonu, tedavi şekli ile ilişkili olduğu bulundu. SONUÇ: Sıklığı gün geçtikçe artarak bir halk sağlığı problemi haline gelen, özellikle baş ve boyun bölgesinin nonmelanotik malign deri tümörlerinin nüks ve metastaz oranlarını ve buna bağlı olarak mortalite ve morbiditesini azaltmak amacıyla ilk başvuru anında prognostik faktörlerin iyi değerlendirilmesi gerektiğine inanmaktayız. Çalışmamızda tümör tipinin, dolaylı olarak tümör çapının, diferansiyasyonun, perinöral invazyonun, kas invazyonunun ve ilk başvuru anında lenf nodu tutulumunun, uzun süreli ve düzenli takibin prognozu etkileyen önemli faktörler olduğu görülmektedir.
Assessment of prognostic factors in cases of nonmelanotic skin cancer in the head and neck region observed among the patients admitted to our university; determining whether surgical tresholds are adequate based on the region of cancer, prognostic factors and whether the operation is conducted in an operating room or a polyclinic, as well as finding out the frequency of relapse and metastases. METHOD: The study involved patients diagnosed with primary nonmelanotic skin cancer (basal cell carcinoma, BCC, and squamous cell carcinoma, SCC) between January, 2009 andJanuary, 2016 at our plastic surgery clinic and were operated on at either the polyclinic or the operating room. The preparates of these patients, archived at the university's pathology department, were also scanned. The patients were reevaluated in terms of pathology preparates, age, sex, tumor type, tumor region, tumor size, surgical tresholds, differentiationof tumor, degree of inflammation, atypical mitosis, neurovascular involvement, muscle invasion, lymph node involvement, relapse and mestastases. Consequently, the results were statistically analyzed. FINDINGS: Of the 297 patients in total, 178 (59%) of whom were males and 119 (40.1%) were females, 83.8% was 60 years of age or older. In terms of the type of tumor, there were 230 casesofBCC (77.4%), 67 casesof SCC (22.6%). The most frequent sub-type of BCC was the nodular variant with 119 cases (51.7%), followed by 75 cases of (%32,6) infiltrate variant. Average tumor diameter was 1.52 cm. Closest lateral treshold average was determined as 4,9 mm for BCC and 2.8 mm for SCC. The lateral treshold was positive for 27 patients (9.1%). The base treshold average was 0.39 cm. The base surgical treshold was positive for 14 patients (4.7%). In the case of SCC, it was observed that the tumor most frequently appeared in the nose, and second most frequently in the periorbitalregion, wheras for BCC patients, the tumor appeared most frequently in the nose region, followed by the malar region.Neurovascular invasion was detected among 33 patients (11.1%). 227 patients (76.4%) were diagnosed with subcutaneousinvasion. 84 patients (28.3%) were determined to have muscle invasion. The most frequently used method of treatment wasrestoration through excision and flap (49.8%). 11 patients suffered from metastases, all of whom were SCC patients. Relapse was observed among 32 patients (10.8%). The rate of 6 relapse was 8.6% for BCC and 17.9% for SCC. It was established that for BCC patients, tumor subtype, differentiation, neurovascular invasion, and the duration of the follow-up affected relapse. Among SCC patients, neurovascular invasion, lymph node involvement at the time of first admission affected relapse.In SCC, metastasis was related to differentiation, neurovascular invasion, muscle invasion and the type of treatment. CONCLUSION: We are convinced that in order to reduce the rate of relapse and metastasis of especially the non-melanotic skin cancer in the head and neck region as well as the ensuing mortality and morbidity, frequency of which is on the fast track to becoming a public health issue, it is crucial to thoroughly evaluate the prognostic factors at the time of first admission. Our study indicates that the tumor type and, by implication, tumor's diameter, differentiation, perineural invasion, muscle invasion and the lymph node involvement at the time of first admission, long-term and regular follow-up are important factors that affect prognosis.
Assessment of prognostic factors in cases of nonmelanotic skin cancer in the head and neck region observed among the patients admitted to our university; determining whether surgical tresholds are adequate based on the region of cancer, prognostic factors and whether the operation is conducted in an operating room or a polyclinic, as well as finding out the frequency of relapse and metastases. METHOD: The study involved patients diagnosed with primary nonmelanotic skin cancer (basal cell carcinoma, BCC, and squamous cell carcinoma, SCC) between January, 2009 andJanuary, 2016 at our plastic surgery clinic and were operated on at either the polyclinic or the operating room. The preparates of these patients, archived at the university's pathology department, were also scanned. The patients were reevaluated in terms of pathology preparates, age, sex, tumor type, tumor region, tumor size, surgical tresholds, differentiationof tumor, degree of inflammation, atypical mitosis, neurovascular involvement, muscle invasion, lymph node involvement, relapse and mestastases. Consequently, the results were statistically analyzed. FINDINGS: Of the 297 patients in total, 178 (59%) of whom were males and 119 (40.1%) were females, 83.8% was 60 years of age or older. In terms of the type of tumor, there were 230 casesofBCC (77.4%), 67 casesof SCC (22.6%). The most frequent sub-type of BCC was the nodular variant with 119 cases (51.7%), followed by 75 cases of (%32,6) infiltrate variant. Average tumor diameter was 1.52 cm. Closest lateral treshold average was determined as 4,9 mm for BCC and 2.8 mm for SCC. The lateral treshold was positive for 27 patients (9.1%). The base treshold average was 0.39 cm. The base surgical treshold was positive for 14 patients (4.7%). In the case of SCC, it was observed that the tumor most frequently appeared in the nose, and second most frequently in the periorbitalregion, wheras for BCC patients, the tumor appeared most frequently in the nose region, followed by the malar region.Neurovascular invasion was detected among 33 patients (11.1%). 227 patients (76.4%) were diagnosed with subcutaneousinvasion. 84 patients (28.3%) were determined to have muscle invasion. The most frequently used method of treatment wasrestoration through excision and flap (49.8%). 11 patients suffered from metastases, all of whom were SCC patients. Relapse was observed among 32 patients (10.8%). The rate of 6 relapse was 8.6% for BCC and 17.9% for SCC. It was established that for BCC patients, tumor subtype, differentiation, neurovascular invasion, and the duration of the follow-up affected relapse. Among SCC patients, neurovascular invasion, lymph node involvement at the time of first admission affected relapse.In SCC, metastasis was related to differentiation, neurovascular invasion, muscle invasion and the type of treatment. CONCLUSION: We are convinced that in order to reduce the rate of relapse and metastasis of especially the non-melanotic skin cancer in the head and neck region as well as the ensuing mortality and morbidity, frequency of which is on the fast track to becoming a public health issue, it is crucial to thoroughly evaluate the prognostic factors at the time of first admission. Our study indicates that the tumor type and, by implication, tumor's diameter, differentiation, perineural invasion, muscle invasion and the lymph node involvement at the time of first admission, long-term and regular follow-up are important factors that affect prognosis.
Açıklama
Anahtar Kelimeler
Deri neoplazmları, Skin neoplasms, Kafa ve boyun neoplazmları, Head and neck neoplasms, Neoplazm metastazları, Neoplasm metastasis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sodalı, T. (2016). Baş boyun bölgesinin non melanotik malign deri tümörlerinin rekürrens ve metastaz kriterlerinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Plastik Cerrahi Anabilim Dalı, Konya.
