Prognostic Factors in Oral Cancer

Saka, Sabah Moshi Hanna (1990) Prognostic Factors in Oral Cancer. PhD thesis, University of Glasgow.

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Abstract

This study was undertaken to assess several prognostic factors in oral squamous cell carcinoma. Structural histological features encountered in the initial biopsy and local resection of these carcinomas were evaluated in relation to nodal metastasis and clinical outcome of the patients. Only patients with carcinomas arising in one of three intra-oral anatomical sites namely, floor of the mouth, tongue and tongue plus floor of mouth were used for the evaluation of the parameters in question. On the histological sections obtained from the initial biopsy of primary tumours, the parameters mitotic phase distribution and the silver stained nucleolar organizer regions (AgNORs) count were evaluated. The histological sections obtained from the local resection specimens of the primary tumours were used for the evaluation of tumour thickness, clearance of surgical margins and the type of tissue associated with positive margins and also for the assessment of malignancy grading using the system which was recently recommended by Anneroth et al. (1987). In patients who underwent neck surgery, the neck dissection specimens were used for the histological examination of the lymph nodes and whether or not these were involved with metastasis. The work presented in this thesis is in two parts. In the first part attention is directed toward assessment of the structural histological features in relation to nodal metastasis of intra-oral carcinoma. The results presented in Chapter 3 describe the value of the parameters in predicting nodal metastasis. The mitotic phase distribution parameters, namely the four apparently normal mitotic phases, abnormal mitoses, apoptotic mitoses and apoptotic cells were found not to be helpful in the prediction of nodal metastasis of carcinomas arising from floor of mouth, tongue or tongue plus floor of mouth. The AgNORs count was found to be an important predictive factor of nodal metastasis in carcinomas arising from floor of mouth and an 85% accurate assessment was possible. This same parameter however, was found not to be of value in predicting nodal metastasis in carcinoma of tongue and carcinomas involving tongue plus floor of mouth. The malignancy grading parameters were assessed comparing two groups with and without nodal metastasis in all the three sites. The total malignancy grade was found not to differ significantly in each site separately or in combinations. The pattern of invasion and tumour-host interaction, by contrast, were found to differ significantly between the group with positive nodes and the group with negative nodes in floor of mouth carcinomas but not in carcinomas of tongue or carcinomas involving tongue plus floor of mouth. Tumour thickness was found to be of predictive value for nodal metastasis in carcinoma of floor of mouth. In carcinomas of tongue and carcinomas involving tongue plus floor of mouth, tumour thickness did not show the same predictive accuracy. However, when comparison was made between the groups with positive nodes and the groups with negative nodes in all the three sites combined, tumour thickness values differed significantly. The second part of the work presented in this thesis was directed towards evaluation of the structural histological features in relation to the clinical outcome of the patients following treatment of their intra-oral squamous carcinomas. Two groups of patients were created in each of the three anatomical sites. One group comprised patients who developed tumour recurrence locally, in the neck or at both sites in a follow-up period of not less than four months and within 24 months. The second group included patients who survived, disease-free a minimum of 24 months following treatment. In Chapters 4, 5 and 6 the three anatomical sites are examined separately. In Chapter 7 the data are related to the clinical outcome in all the three sites combined. Positive surgical margins were more common in patients who developed recurrence. Tumour thickness values demonstrated a highly significant difference between the group of patients who developed recurrence and those who survived, disease-free a minimum of 24 months. The pattern of invasion, stage of invasion and tumour-host interaction also showed significant differences between the groups. Involvement of lymph nodes with metastatic tumour was significantly more frequent in patients who developed tumour recurrence. Extracapsular spread of metastatic tumour was also more cannon in patients who developed recurrence than in patients without recurrence, but the difference in frequency was not significant.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Oncology
Date of Award: 1990
Depositing User: Enlighten Team
Unique ID: glathesis:1990-78071
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 30 Jan 2020 15:41
Last Modified: 30 Jan 2020 15:41
URI: http://theses.gla.ac.uk/id/eprint/78071

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