Carcinoma epidermóide de orofaringe: análise de resultados do tratamento cirúrgico em 2 instituições / Oropharyngeal squamous cell carcinoma: outcomes of primary surgical treatment at two head and neck surgery departments

RESUMO

O objetivo deste estudo foi avaliar os resultados tardios do tratamento cirúrgico de pacientes com carcinoma epidermóide de orofaringe visando a identificação de fatores prognósticos nessa população. Os prontuários de 325 pacientes tratados nos Serviços de Cirurgia de Cabeça e Pescoço do Hospital A C Camargo e Hospital Heliópolis foram revisados. Todos os pacientes foram submetidos à cirurgia com ou sem radioterapia pós-operatória, de 1990 a 2005. Dois estudos foram realizados, o primeiro com 89 pacientes com lesões em estádios clínico I e II. Neste estudo incluímos 20 pacientes tratados no Hospital de Câncer de Barretos. Trinta e sete pacientes (41,6%) apresentavam tumores em estádio I e 52 (58,4%) em estádio II. Sessenta e dois pacientes (69,7%) foram tratados apenas com cirurgia e 27 pacientes foram tratados com cirurgia e radioterapia pós-operatória (30,3%). Durante o seguimento pós-operatório observamos que 26,9% dos casos apresentaram recidiva local, 10,1% recidiva regional e 3,4% metástases à distancia. As taxas de sobrevida global e livre de doença aos 5 anos foram de 60,4% e 59,7% respectivamente. O modelo de Cox demonstrou que os fatores prognósticos independentes para sobrevida global foram grau histológico pouco diferenciado e pN2. No segundo estudo incluímos 256 pacientes com lesões ressecáveis em estádios III e IV. Noventa e cinco pacientes (37,1%) tinham tumores estádio III e 161 em estádio IV (62,9%). Cinquenta e cinco pacientes foram tratados apenas com cirurgia e 201 foram tratados com cirurgia e radioterapia pós-operatória (78,5%) Durante o seguimento pós-operatório observamos 29% de recidiva local, 10,5% de recidiva regional e 7,4% de metástase à distancia. As taxas de sobrevida global e livre de doença aos 5 anos foram de 43% e 54,5%, respectivamente. O modelo de Cox demonstrou que os fatores prognósticos independentes para predição das taxas de sobrevida global foram tamanho do tumor >3cm, pN+RC+ e presença de intenso infiltrado linfocitário peri-tumoral

ABSTRACT

The purpose of this study was to review the late outcomes of primary surgical treatment of patients with squamous cell carcinoma of the oropharynx, aiming to identify prognostic factors in this population. The records of 325 patients treated at Hospital A C Camargo and Hospital Heliópolis were reviewed. All included patients were treated with surgery with or without postoperative radiotherapy from 1990 to 2005. Two different studies were conducted, the first one with 89 patients who had clinical stage I or II cases. For this study 20 patients treated at Hospital de Cancer de Barretos were included. Thirty-seven patients (41.6%) had tumors at stage I and 52 (58.4%) at stage II. Sixty-two patients (69.7%) had surgery only and 27 patients had surgery and postoperative radiotherapy (30.3%). During follow-up, there were 26.9% local recurrences, 10.1% regional recurrences and 3.4% distant metastasis. The 5-year overall survival rate was 60.4% and the 5-year disease free survival was 59.7%. The Cox model demonstrated poorly differentiated (histological grade) and pN2 as independent prognostic markers for decreased overall survival. For the second study 256 patients who had resectable clinical stage III and IV tumors were included. Ninety-five (37.1%) had tumors at stage III, 161 at stage IV (62.9%). Fifth-five patients had surgery only and 201 had surgery and postoperative radiotherapy (78.5%). During follow-up, there were 29% of local recurrences, 10.5% of regional recurrences and 7.4% of distant metastasis. The 5-year overall survival rate was 43.0% and the 5-year disease free survival was 54.5%. The Cox multivariate model demonstrated tumor size >3cm and pN+ECS+ as independent prognostic markers for decreased OS. The presence of intense lymphocytic infiltrate was associated with higher OS rates.