Squamous cell carcinoma of the oral cavity. A review of 176 cases with application of malignancy grading and DNA measurements

Abstract

This retrospective study comprised 176 patients with squamous cell carcinoma of the oral cavity treated at The Linköping University Hospital over a 19-year period. Clinical parameters, microscopic malignancy grading (according to Jakobsson et al. and Glanz and Eichhorn), DNA cytofluorometry, analysis of therapeutic modalities and statistics regarding survival and prognosis are reported. The mean age was 70 years with a male: female ratio of 1.3:1 One hundred and four patients had T1 or T2 tumours and 109 an N0 neck. Cervical lymph node metastases were more frequent in patients with larger tumours (T3 + T4) than in those with smaller (T1 + T2) (P less than 0.01), in tumours with a high malignancy grading compared to those with a low (P less than 0.05) and in DNA non-diploid tumours compared to diploid ones (P less than 0.001). The aneuploid tumours responded better to preoperative radiotherapy than did diploid (P less than 0.01) or polyploid (P less than 0.05) tumours. Eighty-nine per cent of the recurrences occurred within 1 year of initial therapy. Secondary treatment was successful in 15 of 37 (41%) patients in whom the tumour recurred either at the primary site or in regional lymph nodes, but only in 1 of 8 (12%) with recurrences in both locations. Surgery alone or combined with radiotherapy resulted in equivalent survival rates for tumours in stages I and II. In advanced stages combined radiotherapy and surgery gave better survival figures than either modality alone (P less than 0.01; Kaplan-Meier). The presence of lymph node metastases (P less than 0.001), tumour size (P less than 0.01) and tumour ploidy (P less than 0.005) were the only clinical and histological parameters that significantly influenced survival (Cox regression analysis). Twenty-four patients developed a secondary primary malignancy; 21 of these were located in the aerodigestive tract.

Molecular markers as prognostic factors for local recurrence and radioresistance in head and neck squamous cell carcinoma

“…Ploidy failed to predict recurrence (two studies) and response to radiation (two studies). Studies conducted after these reviews are presented in Table 5 [93][94][95][96][97][98][99][100][101][102][103]. These studies generally support the conclusion of the Stell review that nondiploid tumors are associated with poor overall survival.…”

“…The relative importance of aneuploidy in these studies is still unclear, however, because only Westerbeek et al [98] found aneuploidy to be a significant independent predictor of radioresistance in multivariate analysis. In contrast, a significant relationship between diploidy and radioresistance was reported by Tytor et al [93] in T1-4N0-2 oral SCC and by Toffoli et al [100] in T1-2N0 laryngeal SCC. At present, it is difficult to determine from the available literature the relationship between DNA ploidy and response to radiation.…”

Clinical application of proliferating cell nuclear antigen, oncoprotein p53 and tumor front grading analysis in patients operated on for laryngeal cancer

“…This finding is in contradiction to other published reports where the correlation was usually positive or there was no correlation. In general, a positive correlation with N-stage has been observed in the analysis of other factors reflecting cell proliferative properties, such as Ki67 and DNA analysis [5,12,28,31]. The reverse tendency of N-stage and PCNA in our study may be explained by a specific inclusion criteria our study population.…”

Proliferative capacity in head and neck cancer

“…Kearsly et al 32 reported similar findings comprising mostly oral cavity tumors treated by radiotherapy and/or surgery. A better prognosis in diploidy was also described by Tytor et al 31 for oral cavity tumors treated by surgery and/or radiotherapy and by Kokal et al 33 in mostly tumors of the oral cavity and larynx and treated by surgery and/or radiotherapy. These findings were confirmed, by univariate analysis, in some smaller studies on laryngeal tumors treated either by radiotherapy alone 34,37,38 or treated by surgery and/or radiotherapy with or without chemotherapy.…”