Alt dudak skuamoz hücreli karsinomlarda tümör tomurcuklanmasinin prognostik önemi
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Tarih
2020
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Dudak kanserleri, oral kavite kanserlerinin yaklaşık %25-30 unu oluşturur. Larinks kanserlerinden sonra baş-boyun bölgesinde en sık görülen ikinci kanserdir. Dudak kanserlerinin yaklaşık %90'lık kısmını skuamöz hücreli karsinom oluşturmakta ve bunların da yaklaşık %90'ı alt dudak yerleşimli olarak izlenmektedir. Tümör tomurcuklanması (TT), tümörün invaziv sınırında beşten az hücreden oluşan küçük hücre kümelerinin gözlenmesi ile tanımlanan histopatolojik bir bulgudur. Kolorektal kanserlerde tümör tomurcuklanması kapsamlı olarak çalışılmış ve lenf nodu metastazı, kötü prognoz veya nüks ile ilişkili histopatolojik bir bulgu olduğu bildirilmiştir. Biz de baş boyun bölgesi tümörlerinde de çalışılmaya başlanan bu histopatolojik bulguyu alt dudak skuamoz hücreli karsinomlarında çalışarak prognostik faktörlerle ilişkisini belirlemeyi amaçladık. Çalışmamıza Meram Tıp Fakültesi Patoloji Anabilim Dalı' nda 2013-2018 yılları arasında skuamoz hücreli karsinom tanısı alan alt dudak wedge rezeksiyon yapılmış 30 vaka dahil edildi. Hastane bilgi sisteminden klinik ve patoloji raporlarına ulaşılan hastaların, H&E ve PanCK boyalı lamları incelendi. 5'ten az tümör tomurcuğu bulunan vakalar düşük riskli grup, 5 ve 5' ten fazla tümör tomurcuğu bulunanlar yüksek riskli grup olarak belirlendi. Bu sonuçların prognostik faktörlerden yaş, cinsiyet, histolojik derece, lenfovasküler invazyon, perinöral invazyon, tümör çapı, tümör derinliği, lenf nodu metastazı varlığı ve lokal rekürrens/nüks varlığı ile ilişkileri istatistiksel olarak karşılaştırıldı. Verilerin analiz edilmesinde IBM SPSS 22.0 programından yararlanıldı. Tüm analizler için anlamlılık seviyesi p<0,05 olarak kabul edildi. 30 alt dudak skuamoz hücreli karsinomlu olgunun 14' ünün (%46,7) düşük, 16' sının (%53,3) yüksek TT' ye sahip olduğu tespit edildi. Düşük riskli gruptaki 6 vakada tümör tomurcuğu hiç yoktu. PNİ saptanan 6 vakanın tamamı TT yüksek riskli grupta idi. TT düşük vakaların tamamı grade 1; TT yüksek olan vakaların 2' si (%12,5) grade 1, 9' u (%56,3) grade 2, 5' i (%16,7) grade 3 idi. Tümör tomurcuklanması ile perinöral invazyon, histolojik grade ve tümör çapı arasında istatistiksel olarak anlamlı pozitif ilişki saptandı. Literatür taramamıza göre; çalışmamız alt dudak skuamoz hücreli karsinomlarında tümör tomurcuklanmasının prognostik faktörlerle ilişkisini inceleyen ilk çalışmadır. Vakaların ortalama takip süreleri 1 yıl olup bu süre içinde 5 vakada lokal rekürrens/ nüks saptandı. Nüks görülen 5 vakanın 4' ü yüksek TT içermesine rağmen TT ile nüks arasında istatistiksel olarak anlamlı sonuç elde edilmedi. Bunun sebebinin vaka sayısının az olması ile ilişkili olduğu düşünülmüştür. Tümör tomurcuklanmasının prognozla ilişkisi daha geniş serilerle, prospektif ve standardize edilmiş yöntemlerle çalışılarak söylenebilir. Ancak bu çalışmanın sonuçları, TT' nin dudak SHK' lerde prognostik bir faktör olarak kullanılabileceğini düşündürmektedir. Anahtar kelimeler: Alt dudak, skuamöz hücreli karsinom, tümör tomurcuklanması, prognoz
Lip cancers comprise approximately 25-30% of oral cavity cancers. Following laryngeal cancers, they are the second most common cancers seen in head-neck region. Approximately 90% of lip cancers are comprised of squamous cell carcinomas, and 90% of these are seen as located in the lower lip. Tumor budding (TB) is a histological finding defined as detection of small cell cluster in the invasive margin of the tumor which is comprised of less than five cells. Tumor budding has been extensively studied in colorectal cancers and reported to be a histological finding associated with lymph node metastasis, poor prognosis or recurrence. By studying this histopathological finding, which has been started to be studied in head-neck tumors, in squamous cell carcinomas of the lower lip, we aimed to determine its association with prognostic factors. In our study, 30 cases which were diagnosed with squamous cell carcinoma and underwent wedge resection of the lower lip in Meram Faculty of Medicine Department of Pathology between 2013 and 2018 were included. Of the patients whose clinical and pathology reports were accessed via hospital's data processing system; H&E- and PanCK-stained microscopic slides were examined. Cases having less than 5 tumor budding were determined to be the low-risk group and those with 5 and more tumor budding were determined to be the high-risk group. Associations of these results with the prognostic factors including age, gender, histological grade, lymphovascular invasion, perineural invasion, tumor size, tumor depth, presence of lymph node metastasis and presence of local recurrence were compared statistically. For analysis of the data, IBM SPSS 22.0 package program was used. In all analyses, level of significance was considered a p <0.05. Of 30 cases with squamous cell carcinoma of the lower lip; 14 (46.7%) were determined to have low TB and 16 (53.3%) high TB. 6 cases in the low-risk group had no tumor budding. All of the 6 cases with PNI were in the TT high-risk group. All of the TT low cases are grade 1; 2 (12.5%) of cases with high TT were grade 1, 9 (56.3%) were grade 2, 5 (16.7%) were grade 3. A statistically significant association was determined between tumor budding and perineural invasion, histological grade and tumor size. According to our literature search; our study is the first study determining association of tumor budding with prognostic factors in squamous cell carcinomas of the lower lip. The mean follow-up time of the cases was 1 year, and local recurrence / recurrence was detected in 5 cases. Although 4 of 5 recurrent cases included high TT, no statistically significant results were obtained between TT and relapse. The reason for this is thought to be related to the low number of cases. Association of tumor budding with prognosis can be determined by studying in larger series with prospective and standardized methods. However, the results of this study suggest that TT can be used as a prognostic factor in lip SHKs. Keywords: Lower lip, squamous cell carcinoma, tumor budding, prognosis
Lip cancers comprise approximately 25-30% of oral cavity cancers. Following laryngeal cancers, they are the second most common cancers seen in head-neck region. Approximately 90% of lip cancers are comprised of squamous cell carcinomas, and 90% of these are seen as located in the lower lip. Tumor budding (TB) is a histological finding defined as detection of small cell cluster in the invasive margin of the tumor which is comprised of less than five cells. Tumor budding has been extensively studied in colorectal cancers and reported to be a histological finding associated with lymph node metastasis, poor prognosis or recurrence. By studying this histopathological finding, which has been started to be studied in head-neck tumors, in squamous cell carcinomas of the lower lip, we aimed to determine its association with prognostic factors. In our study, 30 cases which were diagnosed with squamous cell carcinoma and underwent wedge resection of the lower lip in Meram Faculty of Medicine Department of Pathology between 2013 and 2018 were included. Of the patients whose clinical and pathology reports were accessed via hospital's data processing system; H&E- and PanCK-stained microscopic slides were examined. Cases having less than 5 tumor budding were determined to be the low-risk group and those with 5 and more tumor budding were determined to be the high-risk group. Associations of these results with the prognostic factors including age, gender, histological grade, lymphovascular invasion, perineural invasion, tumor size, tumor depth, presence of lymph node metastasis and presence of local recurrence were compared statistically. For analysis of the data, IBM SPSS 22.0 package program was used. In all analyses, level of significance was considered a p <0.05. Of 30 cases with squamous cell carcinoma of the lower lip; 14 (46.7%) were determined to have low TB and 16 (53.3%) high TB. 6 cases in the low-risk group had no tumor budding. All of the 6 cases with PNI were in the TT high-risk group. All of the TT low cases are grade 1; 2 (12.5%) of cases with high TT were grade 1, 9 (56.3%) were grade 2, 5 (16.7%) were grade 3. A statistically significant association was determined between tumor budding and perineural invasion, histological grade and tumor size. According to our literature search; our study is the first study determining association of tumor budding with prognostic factors in squamous cell carcinomas of the lower lip. The mean follow-up time of the cases was 1 year, and local recurrence / recurrence was detected in 5 cases. Although 4 of 5 recurrent cases included high TT, no statistically significant results were obtained between TT and relapse. The reason for this is thought to be related to the low number of cases. Association of tumor budding with prognosis can be determined by studying in larger series with prospective and standardized methods. However, the results of this study suggest that TT can be used as a prognostic factor in lip SHKs. Keywords: Lower lip, squamous cell carcinoma, tumor budding, prognosis
Açıklama
Anahtar Kelimeler
Alt dudak, skuamöz hücreli karsinom, tümör tomurcuklanması, prognoz, Lower lip, squamous cell carcinoma, tumor budding, prognosis
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Scopus Q Değeri
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Künye
Alakuş, R. (2020). Alt dudak skuamoz hücreli karsinomlarda tümör tomurcuklanmasinin prognostik önemi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Tıbbi Patoloji Anabilim Dalı, Konya.
