Avaliação das campanhas de prevenção do câncer de boca no impacto do prognóstico e revisão sistemática seguida de metanálise do valor prognóstico do antígeno SCC em carcinomas espinocelulares de cabeça e pescoço
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Data
2017-02-10
Autores
Travassos, Daphine Caxias [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Carcinomas espinocelulares (CEC) de cabeça e pescoço são um problema de saúde pública e, embora avanços nos métodos terapêuticos tenham ocorrido nas últimas décadas, pacientes tardiamente diagnosticados apresentam prognóstico sombrio e taxa de sobrevida reduzida. A inspeção visual da boca é considerada padrão-ouro na detecção precoce de CEC e desordens potencialmente malignas orais (DPMOs), alterações que podem preceder o CEC. Entretanto, características clínicas podem não retratar com fidelidade a extensão da doença. A detecção de biomarcadores em soro humano é um método auxiliar que pode determinar com maior exatidão parâmetros clínicopatológicos. Avaliou-se prontuários de pacientes atendidos, no período de 1993 a 2014, durante as Campanhas de Prevenção do Câncer de Boca (CPCB) e no Serviço de Medicina Bucal (SMB) da Faculdade de Odontologia de Araraquara (FOAr – Unesp), diagnosticados com DPMOs e CEC e a associação entre o comparecimento às CPCB com tamanho do tumor e presença de linfonodos palpáveis. Foram incluídos neste estudo 176 pacientes atendidos nas CPCB e 478 no SMB. Foram diagnosticados 199 casos de CEC, 128 casos de leucoplasia, 75 de queilite actínica e 264 de líquen plano, esta última DPMO apresentou 8 casos de CEC desenvolvidos na mesma região anatômica. Não houve associação entre o comparecimento nas CPCB com tamanho do tumor (p = 0,3834) e presença de linfonodos palpáveis (p = 0,4434), no entanto, tamanhos T1 ou T2 de tumor e ausência de linfonodos foram constatados em maior parte dos pacientes atendidos em CPCB e SMB. Desde 2000, as CPCB da FOAr - Unesp capacitam dentistas da rede pública da região quanto à prevenção e diagnóstico precoce de DPMOs e CEC havendo um aumento no número de diagnósticos de lesões de CEC, principal resultado das CPCB. Também avaliou-se o valor prognóstico dos altos níveis sorológicos do antígeno de carcinoma de células escamosas (SCC-Ag) em características clinicopatológicas de pacientes com CEC de cabeça e pescoço por meio de revisão sistemática seguida de metanálise. Realizou-se buscas nas bases de dados PubMed, SCOPUS e Cochrane Library de Outubro de 1977 a Dezembro de 2015. Dez estudos foram incluídos na metanálise mostrando significância estatística em níveis elevados de SCC-Ag em comparação ao gênero (odds ratio [OR] = 2.99, 95% CI 1.18 - 7.57, P = 0.02 modelo fixo) e estadiamento TNM avançados (OR = 3.18, 95% CI 1.88 - 5.38, P < 0.0001 modelo randomizado). A metanálise sugeriu que níveis elevados de SCC-Ag tem valor prognóstico significativo para o gênero masculino e estadiamento TNM avançado. No entanto, mais estudos com um maior número de casos devem ser realizados para confirmar os resultados encontrados, principalmente, nos grupos com características clínicopatológicas associadas aos altos níveis do antíngeno que apresentaram instabilidade nas análises de sensibilidade.
Head and neck squamous cell carcinoma (HNSCC) is a worldwide public health concern. Although many improvements were done in therapeutic field, advanced diagnosed HNSCC present poor prognosis and low survival rates. Oral visual exams are the most applied method to detect oral SCC (OSCC) and oral potentially malignant disorders (OPMDs), disorders that can precede OSCCC. However, clinical features may not accurately represent real SCC evolution. Thus, tumor markers detection in human serum have been used to precisely determine clinicopathoogical parameters. Patients’ charts diagnosed with OSCC and/or OPMDs who attended oral cancer preventive campaigns (OCPC) and the Oral Medicine Service (OMS) from Araraquara School of Dentistry (São Paulo State University (Unesp)) between 1993 and 2014 were revised. We evaluated the association between OCPC attendance with tumor size and lymph node metastasis. 176 patients from OCPC and 478 patients from OMS were included in this study. A total of 199 OSCC, 128 leukoplakia, 75 actinic cheilitis, and 264 lichen planus cases were diagnosed. From the latter, 8 cases of OSCC arisen of oral sites previously diagnosed as this OPMD. There was no statistically significant difference between OCPC attendance and tumor size (p = 0,4434) and lymph node mestastasis (p = 0,3834), however, T1 or T2 sizes and absence of palpable lymph nodes were major noted in both groups. Since 2000, OCPC are responsible for providing a continuing education program to public healthcare dentists that comprises prevention and diagnosis of OPMDs and OSCC. An increase of diagnosed OSCC by these dentists was observed, this is the main result of the OCPC. We also evaluated the prognostic value of high squamous cell carcinoma antigen (SCC-Ag) levels in clinicopathological features of head and neck squamous cell carcinoma (HNSCC) patients through a systematic review and meta-analysys. PubMed, SCOPUS, and Cochrane Library were searched for relevant studies from October 1977 up to December 2015. Ten studies met inclusion criteria, meta-analysis’ results showed that there were significant differences in high SCC-Ag levels in comparision to gender (odds ratio [OR] = 2.99, 95% CI 1.18 - 7.57, P = 0.02 fixed-effect), and advanced TNM stages (OR = 3.18, 95% CI 1.88 - 5.38, P < 0.0001 random-effect). Our meta-analysis suggests that elevated SCC-Ag levels have a significant prognostic value in males and TNM stage. However, further studies with larger number of cases should be performed to reliably assess these correlations, and particularly those found in groups who showed instable results in sensitivity analysis.
Head and neck squamous cell carcinoma (HNSCC) is a worldwide public health concern. Although many improvements were done in therapeutic field, advanced diagnosed HNSCC present poor prognosis and low survival rates. Oral visual exams are the most applied method to detect oral SCC (OSCC) and oral potentially malignant disorders (OPMDs), disorders that can precede OSCCC. However, clinical features may not accurately represent real SCC evolution. Thus, tumor markers detection in human serum have been used to precisely determine clinicopathoogical parameters. Patients’ charts diagnosed with OSCC and/or OPMDs who attended oral cancer preventive campaigns (OCPC) and the Oral Medicine Service (OMS) from Araraquara School of Dentistry (São Paulo State University (Unesp)) between 1993 and 2014 were revised. We evaluated the association between OCPC attendance with tumor size and lymph node metastasis. 176 patients from OCPC and 478 patients from OMS were included in this study. A total of 199 OSCC, 128 leukoplakia, 75 actinic cheilitis, and 264 lichen planus cases were diagnosed. From the latter, 8 cases of OSCC arisen of oral sites previously diagnosed as this OPMD. There was no statistically significant difference between OCPC attendance and tumor size (p = 0,4434) and lymph node mestastasis (p = 0,3834), however, T1 or T2 sizes and absence of palpable lymph nodes were major noted in both groups. Since 2000, OCPC are responsible for providing a continuing education program to public healthcare dentists that comprises prevention and diagnosis of OPMDs and OSCC. An increase of diagnosed OSCC by these dentists was observed, this is the main result of the OCPC. We also evaluated the prognostic value of high squamous cell carcinoma antigen (SCC-Ag) levels in clinicopathological features of head and neck squamous cell carcinoma (HNSCC) patients through a systematic review and meta-analysys. PubMed, SCOPUS, and Cochrane Library were searched for relevant studies from October 1977 up to December 2015. Ten studies met inclusion criteria, meta-analysis’ results showed that there were significant differences in high SCC-Ag levels in comparision to gender (odds ratio [OR] = 2.99, 95% CI 1.18 - 7.57, P = 0.02 fixed-effect), and advanced TNM stages (OR = 3.18, 95% CI 1.88 - 5.38, P < 0.0001 random-effect). Our meta-analysis suggests that elevated SCC-Ag levels have a significant prognostic value in males and TNM stage. However, further studies with larger number of cases should be performed to reliably assess these correlations, and particularly those found in groups who showed instable results in sensitivity analysis.
Descrição
Palavras-chave
Carcinoma de células escamosas, Programas de rastreamento, Prognóstico, Carcinoma, Squamous Cell, Mass screening, Prognosis