A dor como sintoma inicial do câncer de boca pode ser o primeiro e único indicador da neoplasia. Até o presente momento suas características, à fase do diagnóstico, ainda não são bem definidas, e nem sempre a dor é considerada como critério importante de diagnóstico para o câncer. OBJETIVO. Avaliar a prevalência e as características gerais de dor orofacial, bem como de outros sinais e sintomas, que levaram os pacientes a procurar atendimento à saúde e ao diagnóstico de câncer de cavidade oral ou orofaringe, comparativamente a um grupo controle composto por pacientes sem câncer. MATERIAL E MÉTODO. Dois grupos: a) Grupo Pacientes (GP), formado por 74 pacientes consecutivos do Ambulatório de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que foi dividido em dois subgrupos: cavidade oral (Ca boca - CaB) e orofaringe (Ca orofaringe - CaO) e b) Grupo Controles (CG), formado por 74 pacientes encaminhados para tratamento odontológico convencional no ambulatório da Divisão de Odontologia do HCFMUSP. Foram utilizados os seguintes instrumentos de avaliação: Ficha clínica da Equipe de Dor Orofacial da Divisão de Odontologia do HCFMUSP (EDOF-HC); Escala Visual Analógica (EVA), Escala Numérica de Dor (END), Escala Verbal de Dor (EVD), Questionário de dor McGill; Ficha de Dor Neuropática do Centro de Dor do HCFMUSP; Índice de disfunção de Helkimo; Índice CPOD; Questionário de Qualidade de Vida (UW-QOL) e o Índice de Desempenho de Karnofsky (IDK). RESULTADOS. Os dois grupos foram pareados em relação ao gênero (4:1 homens); idade (58,46 anos no GP e 58,61 GC), raça (2:1 leucoderma) e ocupação. As diferenças estatísticas predominantes no GP foram as seguintes: tabagista/ex-tabagista e etilista/ex-etilista (p < 0,001); motivos de procura por assistência: dor (p < 0,001), úlcera e aumento de volume (p < 0,001); queixa principal: dor (p < 0,001), aumento de volume (p < 0,001) e úlcera (p=0,016); localização da queixa principal: língua e garganta (p < 0,001), ouvido (p=0,033) e palato (p=0,028); prevalência de dor no momento do estudo (p<0,001); problema mais importante nos últimos sete dias (p < 0,001); motivo de procura por assistência médica (p < 0,001); dor constante muitas vezes explosiva em algum momento (p < 0,001); dor espontânea ou provocada (p < 0,001); fatores desencadeantes da dor: mastigação ou deglutição (p=0,001); dor acorda o paciente (p<0,001); dor moderada a forte (EVA=6; p<0,001), (END=7,5; p < 0,001); duração variável (p<0,001); indiferente quanto ao período do dia (p=0,001); múltiplos descritores, destacando-se: pontada, queimação, latejante (p < 0,001) e tipo \"dor de dente\" (p=0,006) e otalgia reflexa uni ou bilateral (p < 0,001). Os seguintes índices também foram piores no GP: índice de disfunção clínica de Helkimo (p < 0,001); índice CPOD (p=0,004); biofilme dental (p=0,002); questionário de dor McGill (p < 0,001); ficha de dor neuropática (p < 0,001); índice de qualidade de vida (p < 0,001) e IDK (p < 0,001). No GP, 25% estavam nos estádios 0, I ou II, e 75% nos III ou IV; o número de profissionais procurados variou de 1 a 9; cirurgião dentista e cirurgião de cabeça e pescoço fizeram os diagnósticos em ambos os subgrupos e o otorrinolaringologista no CaO; pacientes com CaO procuraram mais por médicos. Houve diferença estatística entre os subgrupos CaB e CaO nos seguintes tópicos; dor tipo \"dor de dente\" (p=0,044) e queimação (p=0,016) no CaB; peso (p=0,018), deglutição como desencadeante de dor (p=0,009), garganta como local de queixa principal (p < 0,001) e otalgia bilateral (p=0,004) no CaO. CONCLUSÃO. Os dados deste estudo mostram que a dor foi sintoma presente em toda a fase de diagnóstico dos cânceres de cavidade oral e orofaringe, inclusive nos estágios iniciais. Destacaram-se as seguintes características: gênero masculino, acima de 50 anos de idade, dor difusa (localização variada), intensidade moderada a forte, indiferente ao período do dia, podendo acordar o paciente, predominantemente em pontada, queimação, latejante ou tipo \"dor de dente\", desencadeada por mastigação ou deglutição, otalgia reflexa uni ou bilateral, limitação ou incapacitação da função mandibular, pacientes com a condição clínica claramente comprometida tanto em qualidade de vida como em funcionalidade. Esses dados podem auxiliar no diagnóstico diferencial dos cânceres de boca e orofaringe, principalmente quando há dor persistente e refratária aos tratamentos / Pain as an early symptom of oral cancer may be the first and only indicator of neoplasia. To date, its characteristics at the diagnostic stage are not still well defined, and pain is not always considered as an important diagnostic criterion for cancer. Objective. To evaluate the prevalence and general characteristics of orofacial pain, as well as other signs and symptoms, which led the patients to seek health care and the diagnosis of cancer of the mouth or oropharynx, compared to a control group composed of patients without cancer. Patients and Method: Two groups: a) Patient Group (PG), consisting of 74 consecutive patients from the Head and Neck Surgery Outpatient Clinic of the Hospital das Clínicas of the Medical School of the University of São Paulo, which was divided into two subgroups:oral cancer(CaB) and oropharynx cancer (CaO) and b) Control Group (CG), formed by 74 patients referred for conventional dental treatment in the outpatient clinic of the Dentistry Division of HCFMUSP. The following evaluation instruments were used: Clinical record form of the Orofacial Pain Team of the Dentistry Division of HCFMUSP (EDOF-HC); Visual Analogue Scale (VAS), Numerical Pain Scale (NPS), Verbal Pain Scale (VPS), McGill Pain Questionnaire; Neuropathic Pain chart of the HCFMUSP Pain Center; Helkimo dysfunction index; DFMT,Index; Quality of Life Questionnaire (UW-QOL) and the Karnofsky performance status (KPS).Results. The two groups were compared for gender (4:1 men); age (58.46 years in PG and 58.61 CG), race (2: 1 white) and occupation. The predominant statistical differences in PG were: smoker / ex-smoker and alcoholic/ex- alcoholic (p < 0.001); reasons for seeking care: pain (p < 0.001), ulcer and swelling (p < 0.001); main complaint: pain: (p < 0.001) swelling (p < 0.001) and ulcer (p=0.016). Location of the main complaint: Tongue and throat (p < 0.001), ear (p=0.033) and palate (p = 0.028); prevalence of pain at study time (p < 0.001); the most important issues in the past seven days (p < 0.001);reason for seeking medical care (p < 0.001); constant pain with attacks of explosions (p < 0.001); spontaneous or induced pain (p < 0.001); pain-triggering factors: chewing or swallowing (p=0.001); pain wakes up the patient (p < 0.001); moderate to severe pain (VAS=6, p < 0.001), (NPS=7.5, p < 0.001); variable duration (p < 0.001); regardless of the period of the day (p=0.001); multiple descriptors, such as: jumping, burning and throbbing (p < 0.001) and toothache type (p=0.006) and unilateral or bilateral reflex otalgia (p < 0.001). The following indexes were also worse in PG: Helkimo clinical dysfunction index (p < 0.001); DMFT index (p=0.004); dental biofilm (p = 0.002); McGill pain questionnaire (p < 0.001); neuropathic pain scale (p < 0.001); index of quality of life (p < 0.001) and KPS (p < 0.001). In PG, 25% were in stages 0, I or II, and 75% in stages III or IV; the number of professionals sought ranged from 1 to 9; dentist and head and neck surgeon made the diagnoses in both subgroups and the otolaryngologist in CaO; patients with CaO sought more physicians. There was a statistical difference between CaB and CaO subgroups in the following topics: toothache-like pain (p=0.044), CaB burning (p=0.016) in the CaB; heavy (p=0.018), swallowing as pain trigger (p=0.009), throat as the primary complaint site (p < 0,001) and bilateral otalgia in CaO (p=0.004). Conclusion. The data from this study show that pain was a symptom present throughout the diagnostic phase of oral cancer. The following characteristics were noted in the sample with oral cancer: male gender, over 50 years of age, diffuse pain (varied location), moderate to strong intensity, indifferent to the time of day, being able to awaken the patient, burning, throbbing, stabbing or toothache-like pain, triggered by chewing or swallowing, unilateral or bilateral reflex otalgia, limitation or incapacitation of mandibular function, patients with a clinical condition clearly compromised both in quality of life and in functionality. These data may aid in the differential diagnosis of oral cancer, especially when there is persistent and refractory orofacial pain

Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery. The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food. Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition. Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.

Made available in DSpace on 2014-12-17T15:32:28Z (GMT). No. of bitstreams: 1 Tese_GeorgeJFN.pdf: 2720479 bytes, checksum: 6d72db8b12a0e5f743d69a67430d66b7 (MD5) Previous issue date: 2010-02-18 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Matrix metalloproteinase-7 (MMP-7) and -9 (MMP-9) modulate important functions strictly related to the development, invasion and metastasis of several human cancers among them the squamous cell carcinoma of the tongue (SCCT). However, individual genetic factors such as the functional single nucleotide polymorphisms (SNPs) influence the pattern of protein expression of these MMPs and thus may be related to the variability observed in the clinical behavior of patients with SCCT. In this context, the present cross-sectional study aimed to evaluate the association between the frequency of the functional SNPs MMP-7 -181 A/G and MMP-9 -1562 C/T and the clinical (age, gender and metastasis) and pathological (malignancy histological grading and immunohistochemistry expression) features of SCCT cases. Genotyping of these SNPs were performed by PCR-RFLP on DNA samples from 71 cases of SCCT and 60 individuals without cancer who constitute the control group. Among the results of this research, it was observed that the frequency of the polymorphic alleles MMP-7 -181 G and MMP-9 -1562 T in SCCT patients was 28% and 12%, respectively, and the frequency of the heterozygotes A/G (PR = 2.00; p < 0.001) and C/T (PR = 1.54; p = 0.014) were significantly higher in the patient group than in the controls. The prevalence of patients carrying the combination of SNPs studied was significantly associated with SCCT cases (PR = 2.00; p = 0.011) and metastasis (PR = 2.00; p < 0.001). Furthermore, with the frequency of SNPs analyzed, the age, gender, histological grading and immunoreactivity of MMP-7 and MMP-9 formed clinical and pathological parameters relevant to the identification of population subgroups more related to the development of SCCT and metastasis. Based on these results, it is suggested that the protein expression levels of MMP-7 and -9 substantially influence the balance between their pro- and anticancer biological functions and hence the clinicopathological profile of the squamous cell carcinoma of the tongue / As metaloproteinases da matriz extracelular-7 (MMP-7) e -9 (MMP-9) modulam importantes fun??es relacionadas ao desenvolvimento, invas?o e met?stase de diversos c?nceres humanos, dentre os quais o carcinoma epiderm?ide de l?ngua (CEL). Entretanto, fatores gen?ticos individuais, tais como polimorfismos de nucleot?deo ?nico (SNPs) funcionais, influenciam no padr?o de express?o proteica dessas MMPs, podendo estar relacionados ? variabilidade no comportamento cl?nico tumoral observado em pacientes com CEL. Neste contexto, o presente trabalho objetivou, atrav?s de an?lise em sec??o transversal, estudar a associa??o entre a frequ?ncia dos SNPs funcionais MMP-7 -181 A/G e MMP-9 -1562 C/T e as caracter?sticas cl?nicas (idade, sexo e met?stase) e patol?gicas (grada??o histol?gica e express?o imuno-histoqu?mica) em uma s?rie de casos de CEL. A genotipagem dos referidos SNPs foi executada por PCR-RFLP em amostras de DNA de 71 casos de CEL e de 60 indiv?duos sem c?ncer, que constitu?ram o grupo controle. Dentre os resultados da presente pesquisa, evidenciou-se que a frequ?ncia dos alelos polim?rficos MMP-7 -181 G e MMP-9 -1562 T nos pacientes com CEL foi de 28% e 12%, respectivamente, sendo as frequ?ncias dos heterozigotos A/G (RP = 2.00; p < 0.001) e C/T (RP = 1.54; p = 0.014) significativamente maiores neste grupo de pacientes que no grupo controle. A preval?ncia dos pacientes portadores da combina??o dos SNPs estudados associou-se significativamente aos casos de CEL (RP = 2.00; p = 0.011) e ? met?stase (RP = 2.00; p < 0.001). Ademais, junto ? frequ?ncia dos SNPs analisados, a idade, sexo, grada??o histol?gica e imunoexpress?o da MMP-7 e -9 constitu?ram par?metros clinicopatol?gicos relevantes para a identifica??o de subgrupos populacionais mais predispostos ao desenvolvimento do CEL e met?stase. Frente a estes resultados, sugere-se que os n?veis de express?o da MMP-7 e -9 influenciam consideravelmente no balan?o entre suas fun??es pr? e antineopl?sicas e, consequentemente, no perfil clinicopatol?gico do carcinoma epiderm?ide de l?ngua.

Abstract Cancers of the alimentary tract include many common cancer types, some of which have well-established treatment protocols and relatively good prognosis, such as colorectal cancer, and others, which have generally very poor prognosis. The gastrointestinal canal is colonized by a multitude of bacteria, the effects of which are currently poorly understood. Toll-like receptor 9 (TLR9) in cells of the alimentary tract recognizes the bacterial DNA-fragments and regulates immune functions in the host and the cancer. This thesis examines the function and prognostic significance of Toll-like receptor 9 in oral and esophageal squamous cell carcinoma as well as in esophageal, gastric and colorectal adenocarcinoma. The studies were made using tissue samples from patient cohorts and various cell culture techniques. Our data indicate that high expression of Toll-like receptor 9 in cancer cells associates with metastatic properties in oral and esophageal cancers and poor prognosis in esophageal adenocarcinoma and oral squamous cell carcinoma. Cell culture studies further suggest that TLR9 is functional in alimentary tract cancers and mediates cellular invasion when activated. Based on the results, TLR9 is active in alimentary tract cancers and its expression is related to poor cancer prognosis. Thus, TLR9 may represent a novel therapeutic target in alimentary tract cancers and might provide a link between bacteria and oral and gastrointestinal cancer. / Tiivistelmä Ruuansulatuskanavan syöpiin lukeutuu useita yleisiä syöpätyyppejä, kuten kohtalaisen hyväennusteinen paksusuolen syöpä, jonka hoitokäytäntö on vakiintunut. Toisissa ruuansulatuskanavan syövissä puolestaan ennuste on hyvin huono. Mahasuolikanavaa asuttavat moninaiset bakteerikannat, joiden vaikutuksia ymmärretään vielä kehnosti. Tollinkaltainen reseptori 9 (TLR9) tunnistaa näiden bakteerien DNA-rakenteita ja vaikuttaa yksilön ja syövän immuunivasteeseen. Tämä väitöstutkimus selvittää TLR9:n toimintaa ja ennustevaikutusta suun ja ruokatorven levyepiteelisyövissä, sekä ruokatorven, mahalaukun ja paksusuolen adenokarsinoomassa. Tutkimus toteutettiin käyttäen syöpäpotilaiden kudosnäytteitä sekä soluviljelytekniikoita. Tuloksemme osoittavat, että TLR9:n lisääntynyt ilmentyminen syöpäsoluissa yhdistyy metastasointiin suu- ja ruokatorvisyövissä, sekä korkeaan kuolleisuuteen suun levyepiteelisyövässä ja ruokatorven adenokarsinoomassa. Soluviljelykokeidemme tuloksiin nojaten TLR9 toimii ruuansulatuskanavan syövissä ja sen aktivaatio saa aikaan solujen invasoitumisen. Tutkimustuloksiimme vedoten TLR9 on aktiivinen ja toimiva ruuansulatuskanavan syövissä ja sen ilmentyminen liittyy huonoon ennusteeseen. TLR9 saattaa osoittautua uudeksi syöpähoitojen kohteeksi tai yhdistäväksi tekijäksi syövän ja bakteerien välillä ruuansulatuskanavan syövissä tulevaisuudessa.

Contexte : Peu d’études ont recherché le rôle des facteurs de risque professionnels dans la survenue des cancers des voies aérodigestives supérieures (VADS). Ces études ont été conduites principalement chez des hommes.Objectif : L’objectif de cette thèse était d’étudier les associations entre les cancers des VADS et les expositions professionnelles chez les femmes.Méthodes : Icare est une étude cas-témoins en population générale incluant 296 cas féminins de cancers épidermoïdes des VADS et 775 femmes témoins. Les historiques de carrières recueillis ont été codés et croisés avec les matrices emplois-expositions du programme Matgéné. Outre les intitulés d’emplois, les expositions à 5 solvants chlorés (chloroforme, chlorure de méthylène, perchloréthylène, trichloréthylène, tétrachlorure de carbone), 5 solvants oxygénés (éthylène glycol, tétrahydrofurane, éther éthylique, cétones, alcools), 5 solvants pétroliers (essences carburants, essences spéciales, gazole, benzène, white-spirit) et à 7 poussières et fibres (amiante, farine, cuir, fibres céramiques réfractaires, ciment, laines minérales, silice) ont été étudiées. Les odds-ratios et leurs intervalles de confiance à 95% ajustés sur l’âge, le département, les consommations de tabac et d’alcool ont été estimés par régressions logistiques non conditionnelles.Résultats :Plusieurs professions et secteurs d’activité associés à un risque élevé de cancer des VADS ont été identifiés. Certaines professions (ouvrières de l’alimentation et des boissons, monteuses en appareillage électrique ou électronique, soudeuses) peuvent être à l’origine d’expositions professionnelles aux solvants, aux métaux, aux fumées de soudage et à diverses poussières. Les analyses par nuisance ont mis en évidence des associations significatives entre le risque de cancer des VADS et l’exposition au perchloréthylène et au au trichloréthylène. Aucune association claire n’est observée avec les solvants pétroliers et oxygénés, certains largement utilisés par les femmes L’exposition aux poussières de farine augmente significativement le risque de cancer des VADS. Une exposition probable à l’amiante est associée à une augmentation modérée et non significative du risque. Les analyses par localisation de cancer (cavité orale, pharynx, larynx), limitées par des effectifs faibles, ne mettent pas en évidence d’association spécifique.Conclusion : Nos résultats suggèrent un rôle des expositions professionnelles au trichloréthylène, au perchloréthylène et aux poussières de farine dans la survenue des cancers des VADS chez les femmes. / Background : Few occupational studies have addressed head and neck cancer, and these studies have been predominantly conducted in men. Objective : Our objective was to investigate the associations between head and neck cancer and occupational exposures in women Population and methods : ICARE, a French population-based case–control study, included 296 squamous cell carcinomas of the head and neck (HNSCC) in women and 775 female controls. Lifelong occupational history was collected. Job-exposure matrices were used to assess exposure to five chlorinated solvents (carbon tetrachloride; chloroform; methylene chloride; perchloroethylene; trichloroethylene), 5 petroleum solvents (benzene; special petroleum product; gasoline; white-spirits and other light aromatic mixtures; diesel, fuels and kerosene), 5 oxygenated solvents (alcohols; ketones and esters; ethylene glycol; diethyl ether; tetrahydrofuran) and 7 fibers and dusts (asbestos, flour dust, leather dust, refractory ceramic fibers, cement dust, mineral wools and silica) . An analysis by job title was conducted, and then associations with specific occupational exposures were investigated.Odds ratio (ORs) and 95% confidence intervals (CI), adjusted for smoking, alcohol drinking, age and residence area, were estimated with logistic models. Results : Significantly increased HNSCC risks were found for several jobs and industries. Some of these occupations (food and beverage processors, electrical and electronic equipment assemblers, welders and flame cutters) may entail exposure to agents such as solvents, metals, welding fumes and various dusts. Analyses for specific occupational exposures showed a significantly elevated risk of HNSCC associated with exposure to trichloroethylene and perchloroethylene. There is no clear evidence that petroleum or oxygenated solvents, some of them commonly used by women, are risk factors for HNSCC. Exposure to flour dust increased significantly HNSCC risk. Probable exposure to asbestos was associated with a moderate, non-significant elevation in risk. Analyses by cancer site (oral cavity, pharynx, larynx) were hampered by small numbers and did to reveal any specific association.Conclusion : These findings suggest that occupational exposure to perchloroethylene, trichloroethylene and flour dust may increase the risk of HNSCC in women.

No description available.

L’inclusion récente de la profondeur d’invasion (PI) dans la classification des carcinomes épidermoïdes de la cavité orale de l’American Joint Committee on Cancer (AJCC) a des répercussions cliniques majeures. Plusieurs études ont récemment évalué la fiabilité de diverses modalités d’imagerie et techniques de biopsie pour mesurer la PI en préopératoire. L’objectif premier de ce mémoire est de réviser systématiquement la littérature et comparer les différentes méthodes décrites de mesure de PI en préopératoire pour les carcinomes épidermoïdes de la langue mobile. Le second objectif est d’étudier la précision et la fiabilité de la mesure de PI sur une biopsie au poinçon dans les carcinomes épidermoïdes de stade in situ (Tis)-T1-T2, N0 de la langue mobile. Une revue systématique a été effectuée en suivant le guide PRISMA[1]. Les études évaluant la fiabilité de la PI mesurée sur la biopsie ou l’imagerie médicale, en les comparant à la PI histopathologique finale, ont été inclues dans une méta-analyse afin d’obtenir des coefficients de corrélation combinés pour chaque modalité d’imagerie. L’imagerie par résonnance magnétique (IRM) s’est avérée être la modalité d’imagerie la mieux étudiée et présente une bonne fiabilité. Le computed tomography (CT) scan est peu étudié, mais semble moins fiable. L’échographie linguale ne peut être comparée à ces deux modalités d’imagerie car elle est plus fréquemment utilisée pour mesurer l’épaisseur tumorale que la PI. La seconde étude est une preuve de concept prospective. Un poinçon profond a été utilisé pour échantillonner la portion la plus profonde de carcinomes épidermoïdes de la langue mobile de stade Tis-T1-2, N0 chez 27 patients. Des coefficients de corrélation de Spearman ont été calculés entre la PI estimée à la palpation manuelle, mesurée à la biopsie, et à l’histopathologie. La sensibilité et la spécificité de la biopsie au poinçon pour distinguer le Tis du carcinome épidermoïde invasif ont été calculées. Bien que la PI mesurée à la biopsie ne corrèle pas fortement avec la PI histopathologique, cette preuve de concept est limitée par la taille d’échantillon. La biopsie au poinçon semble toutefois être un outil fiable pour distinguer le Tis de l’invasif. D’autres études sont nécessaires avant de pouvoir recommander l’utilisation systématique de la biopsie pour décider en préopératoire si un évidement cervical électif est nécessaire. / The inclusion of depth of invasion (DOI) in the American Joint Committee on Cancer’s staging system for oral cavity squamous cell carcinoma (SCC) has major clinical impacts. Recent studies have evaluated the reliability of imaging modalities and biopsy techniques to measure DOI preoperatively. The first objective of this master’s thesis is to systematically review and compare the preoperative DOI measurement methods that have been studied so far in oral tongue SCC (OTSCC). The second objective is to prospectively study the precision and reliability of punch biopsy to measure DOI preoperatively in early (in situ (Tis)-T1-T2, N0) OTSCC, and its ability to distinguish Tis from invasive carcinoma. A systematic review was conducted according to the PRISMA guidelines. Studies that evaluated the reliability of DOI measured on biopsy or imaging (rDOI) by comparing it to DOI on histopathology (pDOI) were included in a meta-analysis to obtain pooled correlation coefficients for each imaging modality. Overall, magnetic resonance imaging (MRI) is the better studied modality. It has a good reliability to measure preoperative rDOI in OTSCC. CT is less studied but appears to be less reliable. Ultrasound (US) cannot be compared to these imaging modality as it has been used more often to measure tumor thickness (TT) than DOI. The second study is a prospective proof-of-concept. A deep punch biopsy was used to sample tumors preoperatively in the deepest part of the tumor in 27 patients with early (Tis-T12, N0) oral tongue squamous cell carcinoma. Spearman’s correlations were calculated between DOI measured on digital palpation (cDOI), biopsy (bDOI) and final pDOI. The sensitivity and specificity of punch biopsy to distinguish Tis from invasive carcinoma was also calculated. Although bDOI does not seem to correlate strongly with pDOI, this proof-of-concept was limited by a small sample size. Punch biopsy appears to be a reliable tool to distinguish Tis from invasive carcinoma. Further studies on punch biopsy are needed to recommend its use to evaluate pDOI preoperatively and determine whether elective neck dissection is necessary in early OTSCC.

No description available.

Objective: In many countries the access to high quality medical service depends on socioeconomic factors. Therefore, these factors are associated with the treatment and prognosis of many diseases. In Germany health care is claimed to be independent from such factors due to obligatory health insurance and a well-developed medical infrastructure. Thus, socioeconomically caused health disparities should be absent. The aim of this study was to analyze the association between socioeconomic factors and the survival of oral cavity cancer in Germany. Patients and methods: In this descriptive cohort study socioeconomic status related factors as well as demographic, tumor-specific, and comorbidity factors of 500 patients treated for oral cavity cancer were obtained in the university hospital of Dresden. Pearson correlation was used to describe associations between continuous variables. Associations between categorical variables were assessed using the chi-square test. Overall and recurrence-free survival were studied using the Kaplan-Meier method. Log-rank test was carried out to test between-group differences. Cox proportional hazard models were used to estimate the risk of death and the risk of recurrence. Results: Significant differences in overall survival were found between the different educational levels and sex. Seventy-nine percent of the patients did not have a university degree or master craftsman/craftswoman. Less discrepancy was observed according to the marital status (49.4% married/engaged vs. 47.8% single, divorced, or widowed). In the multivariable analysis only sex, age at diagnosis, the Charlson score, the number of positive lymph nodes, and the nodal status were identified as independent predictors for overall survival whereas sex and the age at diagnosis were identified as independent predictors for recurrence-free survival. Conclusion: Despite the equitable health system in Germany, significant associations between overall survival of oral cavity cancer and different socioeconomic factors could be found. For elimination of these disparities, health education programs should be established in socially deprived areas. Furthermore, clinicians should keep these factors in mind when determining recall periods for dental check-ups.