Treatment failure and margin status in head and neck cancer. A critical view on the potential value of molecular pathology
Treatment failure and margin status in head and neck cancer. A critical view on the potential value of molecular pathology
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DOI：
10.1016/s1368-8375(01)00092-6
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发表时间：
2002-07-01
期刊：
影响因子：
4.8
通讯作者：
Koole, R
中科院分区：
文献类型：
--
作者：
Slootweg, PJ;Hordijk, GJ;Koole, R
分子病理学可以显示未被组织学检测到的肿瘤细胞。人们认为这些细胞会对预后产生负面影响，而检测到它们将导致更合适的治疗，提高患者的生存率。我们的理论认为，病理学家忽视的手术边缘的肿瘤细胞应该通过在组织学上报告无肿瘤边缘的患者的原发部位引起复发来证明其临床意义。为了评估这一假设，我们调查了组织学上确定的手术切缘状态对预后的影响。构成本研究基础的材料包括394例在1990-1995年间因原发肿瘤切除的患者。207例患者。通过手术标本的常规组织病理学检查，初步治疗完成。187例患者。最初的治疗是不完整的，确定其肿瘤或接近边缘。或轻微。中度或重度发育不良或在档案边缘原位癌。分别记录两组治疗失败的原因。在无肿瘤边缘组中，16.9%的患者有第二原发头颈癌，8.2%的患者在肺部有第二肿瘤，10.6%的患者在颈部有复发，2.9%的患者有远处转移，3.9%的患者在原发肿瘤的同一部位有局部复发。对于无肿瘤边缘的组，这些数字如下：头颈部的第二次原发：17.1%。第二原发于肺部：7.0%，颈部复发：11.8%，远处转移：8.0%，原发部位局部复发：21.9%。局部复发是罕见的病人适合病理报告切除完全。尽管在手术边缘可能存在逃避组织学检测的肿瘤细胞。它们的临床影响似乎几乎可以忽略不计。(C) 2002 Elsevier Science Ltd.版权所有。
Molecular pathology may demonstrate tumour cells not detected by histology. The idea has emerged that these cells influence the prognosis negatively and that their detection will lead to more appropriate treatment and improved patient survival. We theorized that tumour cells at surgical margins overlooked by the pathologist should demonstrate their clinical significance by causing recurrences at the primary site in the patients reported to have tumour-free margins by histology. To assess this assumption, we investigated the prognostic influence of the histololgically determined status of the surgical margins. The material that formed the basis of this study consisted of 394 patients that underwent resection for their primary tumour during the years 1990-1995. In 207 patients. initial treatment was complete as assessed by conventional histopathological examination of the surgical specimen. In 187 patients. initial treatment was incomplete, defined its tumour or close to the margin. or mild. moderate or severe dysplasia or in situ cancer at file margin. Causes for treatment failure were recorded for both groups separately. In the group with tumour-free margins, 16.9% had a second primary head and neck cancer, 8.2% had a second tumour in the lung, 10.6% had recurrent disease in the neck, 2.9% had distant metastasis, and 3.9% had local recurrence at the same site as the primary cancer. For the group without tumour-free margins, these figures were the following: second primary in the head and neck area: 17.1%. second primary in the lung: 7.0%, recurrent disease in the neck: 11.8% distant metastasis: 8.0% and local recurrence at the primary site: 21.9%. Local recurrences were rare in patients fit which the pathologist reported the resection to be complete. Although there may be tumour Cells in surgical margins that evade histological detection. their clinical impact appears to be almost negligible. (C) 2002 Elsevier Science Ltd. All rights reserved.