Abstract

MUNOZ-GUERRA, M.F.; CAPOTE MORENO, A.L.; GOMEZ MARAZUELA, E.M.  and  GAMALLO AMAT, C.. Early stage oral cancer: prognosis with regard to histological grading, intratumoral lymphangiogenesis, and the expression of vascular endothelial growth factor-C (VEGF-C). Rev Esp Cirug Oral y Maxilofac [online]. 2006, vol.28, n.1, pp.25-40. ISSN 2173-9161.

Objectives. Histological grading systems have been classically used as a prognostic factor and clinical behavior markers in oral squamous cell carcinoma (OSCC). However, their prognostic usefulness remains controversial. Our aim was to evaluate the presence of intratumoral lymphangiogenesis (IL), a new morphological finding, in a retrospective analysis of paraffin embedded tissue samples that corresponded to a group of early stage oral squamous cell carcinoma cases, and to relate this with histological grading systems while keeping in mind their prognostic significance. We also wanted to determine if the expression of vascular endothelial growth factor-C (VEGF-C) is correlated with the evolution of the disease. Design. We performed a retrospective analysis of 96 patients with OSCC. All cases were T1-T2 neoplasms and were treated primarily by local resection and elective neck dissection that showed no neck involvement. In the group of 96 specimens, we analyzed IL using the specific marker PA2.26 for lymphatic endothelium. Also, we studied the expression of (VEGF-C). All cases were classified according to the histological grading systems described by Broders, Anneroth and Bryne. The statistical analysis was based on the univariate analysis of cause-specific survival and disease recurrence free-survival according to the Kaplan-Meier method. Results. The group of patients without intratumoral lymphangiogenesis showed a better prognosis with regard to survival and disease- free period, but the difference was not statistically significant. The study showed no relationship between VEGF-C expression and the presence of intratumoral lymphangiogenesis. However, no recurrences were observed in the group without VEGF-C expression. The comparative analysis of the histological grading system showed a statistical relationship between the Broders and Anneroth systems (p<0.01) and between the Broders and Bryne systems (p<0.001). Our study demonstrated an inverse relationship between the values of the Anneroth system (p<0.01) - Bryne system (p<0.001) and the presence of intratumoral lymphangiogenesis. Conclusion. The clinical value of the histological grading systems can increase by including new parameters that take into account the biological behavior of the tumor. Expression of VEGF-C and intratumoral lymphatics may thus be useful prognostic markers for oral squamous cell carcinoma.

Keywords : Oral cancer; Prognostic factors; Grading systems; Lymphangiogenesis; Vascular endothelial growth factor.

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