Analysis of clinical and histopathological prognostic factors in patients with oropharynx squamous carcinoma submitted to radiotherapy alone or in combination with systemic chemotherapy / Análise de fatores prognósticos clínicos e histopatológicos em pacientes portadores de carcinoma epidermóide da orofaringe submetidos à radioterapia isolada ou associada à quimioterapia sistêmica

Paola Andrea Galbiatti Pedruzzi

The size of a tumor is the most important anatomic factor for assessing the prognosis and planning the treatment of head and neck tumors.. In addition to TNM, other factors contribute to the assessment of the prognosis, such as symptoms, comorbidities, macroscopic and microscopic features of the tumor, among others. The objective of this study was to identify demographic, clinical, tumoral and histopathological prognostic factors associated with patient survival and treatment response. We reviewed 361 medical records of patients with oropharynx squamous carcinoma, admitted to the Hospital A. C. Camargo and Hospital Erasto Gaertner, submitted to radiotherapy alone or in combination with chemotherapy, from 1990 to 2001. Among the variables we studied, the severity of the symptoms was assessed according to Piccirillos and Puglianos staging systems. We also analyzed the staging systems developed by Berg, TANIS 3, TANIS 4, Hart, Kiricuta and Hall, which are TNM modifications based upon the regrouping of the T and N categories, aiming to improve the prognosis assessment. As for the statistical analysis, we used the Kaplan-Meier method and Cox model. The main results were the following: most tumors were sited at the tonsil (47%) or base of the tongue (28%), at clinical stage III (13%) or IV (80%). Radiotherapy alone was used in 73% of the cases. Treatment response was achieved by 65% of the patients, mortality was seen in 80% of the cases. The average follow-up time was of 24 months, and the significant variables in the assessment of overall survival, which was of 17.6 % at 5 years, were the following: age in years ( 45: 13%; 46 55: 23%; 56 65: 19%; 66 75: 12%; >75: 7%) (p = 0.0425); Zubrod scale (1: 24%; 2: 8%; 3: 0%) (p <0.001); weight loss (present: 13%; absent: 29%) (p = 0.0022); comorbidities (present: 11%; absent: 26%) (p = 0.0006); Piccirillos staging (local: 31%; extra-local: 15%; regional: 14%) (p<0.001); Puglianos staging (none: 44%; mild: 15%; moderate: 13%; severe: 12%) (p <0.001); involvement of soft areas (absent: 21%; carotid area: 4%; masticatory area: 0%) (p <0.001); lymph node mobility (movable: 15%; semifixed: 12%; fixed: 6%) (p = 0.03); RT doses (<60 Gy: 3%; 60 a 69Gy: 14%; 70 Gy: 22%) (p <0,001). All the staging systems were significant for survival analysis (p <0.001), and the ones that stood out were TANIS 3, Hart and Berg. Treatment response was better in the soft palate and exophytic tumors (p = 0.022). The multivariate analysis showed, as independent factors, the Zubrod scale, Puglianos clinical severity staging system, comorbidities, Bergs staging and the radiotherapy dose. We have come to the conclusion that the combination of clinical factors, such as symptomatology, the patients general condition, weight loss and comorbidities, leads to a highly relevant stage of clinical severity. As far as the prognosis assessment of oropharynx carcinoma is concerned, such factors may be associated with the TNM morphological features

AUTOR(ES)

DATA DE PUBLICAÇÃO

RESUMO

ASSUNTO(S)

ACESSO AO ARTIGO

Documentos Relacionados