Invasão perineural e correlação com sobrevida em carcinomas espinocelulares orais - Dominguette, Alexandre Augusto Sarto [UNESP] (Universidade Estadual Paulista (Unesp), 2023)
O prognóstico de pacientes com carcinoma espinocelular (CEC) oral é afetado por muitos fatores, sendo crítico na decisão de quais tratamentos serão instituídos. Dentre esses fatores destacam-se o estadiamento clínico e histopatológico, o tipo histológico, e a presença de invasão perineural (PNI), embora seja controversa. O objetivo dessa pesquisa foi verificar a correlação entre PNI e dados clínico-patológicos de pacientes diagnosticados com CEC oral tratados no Hospital Bom Pastor (Varginha-MG [2004 a 2014]). PNI foi avaliada a partir de laudos histopatológicos e por meio de análise histopatológica revisional utilizando-se a coloração de hematoxilina e eosina (H&E) e o anticorpo contra S100. Com os dados coletados e as novas análises realizadas, foi efetuado teste de Qui-quadrado (análise univariada) e regressão logística (análise multivariada). A taxa de sobrevida e o teste log-rank foram calculados pelo método de Kaplan-Meier. Os dados iniciais foram obtidos de 310 pacientes, havendo forte predomínio masculino (78,7%) e idade média de 60,1 anos. A língua foi a região mais prevalente (40,3%). Os tumores moderadamente diferenciados somaram 52,2%. Os estádios IV (54.5%) e III (21,6%) predominaram. A radioterapia associada a quimioterapia foi o tratamento predominante (33,5%). Pacientes com menores taxas de sobrevida apresentaram maiores percentuais de PNI, cerca de 11,4%. Obtivemos 39 peças em parafina que foram cortadas e coradas em H&E e realizadas as imuno- histoquímicas para S100 e Ki67. Nesta nova análise, sete casos foram positivos para PNI utilizando a coloração de H&E (17,9%), aumentando para 20 (51,2%) casos com ajuda de imuno-histoquímica pra S100 (p=0,004). O PNI-S100 intraneural foi o tipo mais prevalente (n = 9), seguida do envolvimento total do nervo (n=8). Todos os pacientes com idade inferior a 50 anos foram PNI-S100 positivos. Pacientes fumantes+etilistas representaram 80,0% de todos os casos PNI-S100 positivos. Os tumores N0 e M0 representaram a maioria dos casos positivos para PNI-S100. Todos os casos PNI-S100 positivos com recorrência locorregional apresentaram invasão intraneural (p=0,001). Pacientes fumantes+etilistas tem 2 vezes mais chances de apresentar PNI-S100. Portanto, pudemos concluir que o uso da imuno-histoquímica para S100 melhora a acurácia diagnóstica de PNI, reduzindo os erros alfa e beta. PNI-S100 intraneural é preditiva de recidiva locorregional no CEC oral.

The prognosis of patients with oral squamous cell carcinoma (OSCC) is affected by many factors, all of which are critical in deciding which treatments to apply. Among these factors, those that stand out are the clinical and histopathological staging, the histological type, and the presence of perineural invasion (PNI), though this is controversial. The objective of this research was to verify the correlation between PNI and clinicopathological data of patients diagnosed with OSCC treated at Bom Pastor Hospital (Varginha-MG [2004 to 2014]). PNI was evaluated by histopathological reports and through revised histopathological analysis using hematoxylin and eosin (H&E) staining and the antibody against S100. After collecting the data and performing the new analyzes, we performed the Chi-square test (univariate analysis) and logistic regression (multivariate analysis). Survival rate and log-rank test were calculated using the Kaplan-Meier method. Initial data were obtained from 310 patients, who were predominantly male (78.7%) with a mean age of 60.1 years. The tongue was found to be the most prevalent region (40.3%), and moderately differentiated tumors accounted for 52.2%. Stages IV (54.5%) and III (21.6%) predominated. Radiotherapy associated with chemotherapy was the most common treatment (33.5%). Patients with lower survival rates had higher percentages of PNI, around 11.4%. We obtained 39 samples in paraffin that were cut and stained in H&E, and immunohistochemistry for S100 and Ki67 was performed. In this new analysis, seven cases were positive for PNI using H&E staining (17.9%), increasing to 20 (51.2%) cases with the use of immunohistochemistry for S100 (p=0.004). Intraneural PNI-S100 was the most prevalent type (n=9), followed by total nerve involvement (n=8). All patients younger than 50 years old were PNI-S100 positive. Patients who were smokers & alcoholics represented 80.0% of all PNIS100 positive cases. N0 and M0 tumors represented the majority of positive cases for PNI-S100. All PNI-S100 positive cases with locoregional recurrence showed intraneural invasion (p=0.001). Smokers & alcoholics are 2 times more likely to present PNI-S100. Therefore, we can conclude that the use of immunohistochemistry for S100 improves the diagnostic accuracy of PNI, reducing alpha and beta errors. Intraneural PNI-S100 predicts locoregional recurrence in OSCC.
Perineural invasion and correlation with survival in oral squamous cell carcinoma
Keywords: Carcinoma de Células Escamosas.; Imuno-Histoquímica; Proteínas S100; Análise de Sobrevida; Carcinoma, Squamous Cell; Immunohistochemistry; S100 Proteins; . Survival Analysis