Perfil epidemiológico e fatores de risco para o surgimento de carcinoma espinocelular oral não associado a tabaco e álcool
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Data
2022-03-11
Autores
Biagioni, Gabriela Baraldo
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O carcinoma espinocelular oral (CEO) é um dos cânceres mais prevalentes em cabeça e pescoço no mundo, sendo mais comum em homens, embora a proporção homem/mulher tenda a diminuir. O tabaco e o álcool constituem os principais fatores de risco para o desenvolvimento do CEO, sendo pessoas acima dos 40 anos as mais acometidas. Entretanto, a incidência de CEO em pacientes com menos de 40 anos e mais de 60 anos, além de pacientes não expostos ao tabaco e o álcool, vem aumentando progressivamente. O objetivo deste estudo foi o de estabelecer um perfil epidemiológico dos pacientes com CEO não associado a tabaco e álcool. Para isso, foram usados prontuários de pacientes do Serviço de Medicina Bucal (SMB) da Faculdade de Odontologia de Araraquara (Unesp) atendidos no período de 1995 a 2019. Foram analisados 12.145 prontuários, tendo sido identificados 580 prontuários de pacientes que apresentaram neoplasias orais. Os critérios de inclusão e não inclusão foram aplicados e o grupo de estudo foi composto por 27 prontuários (pacientes com CEO não expostos a tabaco e álcool) e por 99 prontuários no grupo controle (pacientes com CEO expostos a tabaco e álcool). Destes prontuários foram coletadas informações referentes à idade, gênero, etnia, saúde sistêmica, diagnóstico histopatológico, localização anatômica, entre outras. Pacientes do gênero feminino foram as mais acometidas pelo CEO sem exposição ao tabaco e álcool, sendo a maioria de etnia branca. Nosso grupo de estudo apresentou maior prevalência para a faixa etária dos 71 ou mais e maior prevalência por pessoas casadas. Histologicamente, os carcinomas no grupo de estudo se apresentaram como bem diferenciados (40,7%). Em relação ao tamanho, prevaleceram os carcinomas com até 2 cm de diâmetro (40,7%) no grupo de estudo. A frequência de desordens potencialmente malignas orais (DPMOs) não se apresentou estatisticamente significativa para o surgimento de CEO no grupo de estudo. Ainda no grupo de estudo, a língua, a mucosa jugal, o rebordo alveolar e a gengiva foram as localizações anatômicas mais comuns. O grupo controle apresentou prevalência pelo gênero masculino, brancos e com maior prevalência para a faixa etária dos 51 a 60 anos. Não houve diferenças quantitativas entre os carcinomas bem diferenciado e moderadamente diferenciado e quanto ao tamanho das lesões (até 2 cm e 4 cm ou mais de diâmetro) neste grupo e carcinomas invasivos foram os mais prevalentes. Houve uma diferença entre os grupos quanto à presença de linfonodos palpáveis, sendo a cadeia submentoniana (mais prevalente no grupo controle) a responsável por essa diferença. A língua, o assoalho bucal e o rebordo alveolar foram as localizações anatômicas mais acometidas no grupo controle. Conclui-se que o CEO não associado a tabaco e álcool possui maior prevalência em mulheres, brancas, acima dos 71 anos de idade, que usam próteses removíveis e que apresentam lesões em língua, mucosa jugal, rebordo alveolar e gengiva. Apresenta-se como bem diferenciado e sem metástase linfonodal, sendo menos agressivo e com melhor prognóstico. Ainda, problemas cardiovasculares, problemas endócrinos, uso de anti-hipertensivos e uso de outros medicamentos podem ser considerados fatores de risco para o desenvolvimento do CEO sem associação ao tabaco e álcool.
Oral squamous cell carcinoma (OSCC) is one of the most prevalent head and neck cancers in the world, being more common in men, although the men/women ratio tends to decrease. Tobacco and alcohol are the main risk factors for the development of OSCC, with people over 40 years old being the most affected. Nevertheless, the incidence of OSCC in patients younger than 40 years old and older than 60 years old, in addition to patients not exposed to tobacco and alcohol, has been increasing progressively. The aim of this study was to establish an epidemiological profile of patients with OSCC not associated with tobacco and alcohol. For this, medical records of patients from the Oral Medicine Service (OMS) of the Faculty of Dentistry of Araraquara (Unesp) treated from 1995 to 2019 were used. A total of 12.145 medical records were analyzed and 580 medical records of patients who had oral neoplasms were identified. Inclusion and non-inclusion criteria were applied and the study group consisted of 27 medical records (patients with OSCC not exposed to tobacco and alcohol) and 99 files in the control group (patients with OSCC exposed to tobacco and alcohol). From these files, information was collected regarding age, gender, ethnicity, systemic health, histopathological diagnosis, anatomical location, among others. Female patients were the most affected by the OSCC without exposure to tobacco and alcohol, the majority being white. Our study group had a higher prevalence for the age group of 71 over and a higher prevalence for married people. Histologically, the carcinomas in the study group were well-differentiated (40,7%). Regarding size, carcinomas up to 2 cm in diameter prevailed (40,7%) in the study group. The frequency of potentially malignant oral disorders (PMODs) was not statistically significant for the emergence of OSCC in the study group. Still in the study group, the tongue, the buccal mucosa, the alveolar ridge and the gingiva were the most common anatomical locations. The control group showed a prevalence of males, whites and with a higher prevalence for the age group from 51 to 60 years old. There were no quantitative differences between well-differentiated and moderately differentiated carcinomas and in terms of lesion size (up to 2 cm and 4 cm or more in diameter) in this group, and invasive carcinomas were the most prevalent. There was a difference between the groups regarding the presence of palpable lymph nodes, with the submental chain (more prevalent in the control group) being responsible for this difference. The tongue, the floor of the mouth and the alveolar ridge were the most affected anatomical locations in the control group. It is concluded that OSCC not associated with tobacco and alcohol has a higher prevalence in white women, over 71 years old, who use removable dentures and who have lesions on the tongue, cheek mucosa, alveolar ridge and gingiva. It presents as well-differentiated and without lymph node metastasis, being less aggressive and with a better prognosis. Furthermore, cardiovascular and endocrine problems, use of antihypertensive drugs and use of other medications can be considered risk factors for the development of OSCC without association with tobacco and alcohol.
Oral squamous cell carcinoma (OSCC) is one of the most prevalent head and neck cancers in the world, being more common in men, although the men/women ratio tends to decrease. Tobacco and alcohol are the main risk factors for the development of OSCC, with people over 40 years old being the most affected. Nevertheless, the incidence of OSCC in patients younger than 40 years old and older than 60 years old, in addition to patients not exposed to tobacco and alcohol, has been increasing progressively. The aim of this study was to establish an epidemiological profile of patients with OSCC not associated with tobacco and alcohol. For this, medical records of patients from the Oral Medicine Service (OMS) of the Faculty of Dentistry of Araraquara (Unesp) treated from 1995 to 2019 were used. A total of 12.145 medical records were analyzed and 580 medical records of patients who had oral neoplasms were identified. Inclusion and non-inclusion criteria were applied and the study group consisted of 27 medical records (patients with OSCC not exposed to tobacco and alcohol) and 99 files in the control group (patients with OSCC exposed to tobacco and alcohol). From these files, information was collected regarding age, gender, ethnicity, systemic health, histopathological diagnosis, anatomical location, among others. Female patients were the most affected by the OSCC without exposure to tobacco and alcohol, the majority being white. Our study group had a higher prevalence for the age group of 71 over and a higher prevalence for married people. Histologically, the carcinomas in the study group were well-differentiated (40,7%). Regarding size, carcinomas up to 2 cm in diameter prevailed (40,7%) in the study group. The frequency of potentially malignant oral disorders (PMODs) was not statistically significant for the emergence of OSCC in the study group. Still in the study group, the tongue, the buccal mucosa, the alveolar ridge and the gingiva were the most common anatomical locations. The control group showed a prevalence of males, whites and with a higher prevalence for the age group from 51 to 60 years old. There were no quantitative differences between well-differentiated and moderately differentiated carcinomas and in terms of lesion size (up to 2 cm and 4 cm or more in diameter) in this group, and invasive carcinomas were the most prevalent. There was a difference between the groups regarding the presence of palpable lymph nodes, with the submental chain (more prevalent in the control group) being responsible for this difference. The tongue, the floor of the mouth and the alveolar ridge were the most affected anatomical locations in the control group. It is concluded that OSCC not associated with tobacco and alcohol has a higher prevalence in white women, over 71 years old, who use removable dentures and who have lesions on the tongue, cheek mucosa, alveolar ridge and gingiva. It presents as well-differentiated and without lymph node metastasis, being less aggressive and with a better prognosis. Furthermore, cardiovascular and endocrine problems, use of antihypertensive drugs and use of other medications can be considered risk factors for the development of OSCC without association with tobacco and alcohol.
Descrição
Palavras-chave
Neoplasias bucais, Carcinoma de células escamosas, Não fumantes, Alcoolismo, Mouth neoplasms, Carcinoma, squamous cell, Non-smokers, Alcoholism