• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Master's Dissertation
DOI
10.11606/D.5.2007.tde-20022009-134436
Document
Author
Full name
Paola Andrea Galbiatti Pedruzzi
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2007
Supervisor
Committee
Kowalski, Luiz Paulo (President)
Lehn, Carlos Neutzling
Walder, Fernando
Title in Portuguese
Análise de fatores prognósticos clínicos e histopatológicos em pacientes portadores de carcinoma epidermóide da orofaringe submetidos à radioterapia isolada ou associada à quimioterapia sistêmica
Keywords in Portuguese
Carcinoma da orofaringe
Estadiamento
Fatores prognósticos
Abstract in Portuguese
A extensão anatômica do tumor é o fator mais importante na avaliação do prognóstico e planejamento do tratamento dos carcinomas epidermóides da cabeça e do pescoço. Além do TNM, outros parâmetros relacionados ao paciente e ao tumor auxiliam na avaliação do prognóstico. Este estudo tem por objetivo identificar fatores prognósticos demográficos, clínicos, tumorais e histopatológicos, associados à sobrevida e resposta ao tratamento no carcinoma da orofaringe. Trata-se de uma análise de 361 pacientes, submetidos à radioterapia exclusiva ou associada à quimioterapia, de 1990 a 2001, no Hospital A. C. Camargo (São Paulo) e Hospital Erasto Gaertner (Curitiba, Paraná). Entre as variáveis estudadas, encontra-se a gravidade dos sintomas, avaliada conforme o modelo de Piccirillo e Pugliano. Foram analisados os sistemas de estadiamento de Berg, TANIS 3, TANIS 4, Hart, Kiricuta e Hall, que são modificações do TNM feitas a partir do reagrupando das categorias T e N, com a finalidade de melhorar a avaliação do prognóstico. A análise estatística utilizou o método de Kaplan-Meier e o modelo de riscos proporcionais de Cox. Os principais resultados foram que a maioria dos tumores era da tonsila (47%) ou base da língua (28%), estádios clínicos III (13%) e IV (80%). A radioterapia exclusiva foi empregada em 73% dos casos. Houve resposta ao tratamento em 65% dos casos e 80% dos pacientes foram a óbito pela doença. O tempo médio de seguimento foi de 24 meses, e as variáveis significativas na avaliação da sobrevida global, que aos 5 anos foi de 18%, foram: idade em anos ( 45: 13%; 46 55: 23%; 56 65: 19%; 66 75: 12%; > 75: 7%) (p = 0,0425); índice de Zubrod (1: 24%; 2: 8%; 3: 0%) (p < 0,001); emagrecimento (presente: 13%; ausente: 29%) (p = 0,0022); comorbidades (presentes: 11%; ausentes: 26%) (p < 0,001); estádio de Piccirillo (local: 31%, extra-local: 15%; regional: 14%) (p< 0,001); estádio de Pugliano (nenhum: 44%; leve: 15%; moderado: 13%; severo: 12%) (p< 0,001); envolvimento de partes moles (ausente: 21%; espaço carotídeo: 4%; espaço mastigatório: 0%) (p < 0,001); mobilidade dos linfonodos (móveis: 15%; semi-fixos: 12%; fixos: 6%) (p = 0,0300); dose de RT (< 60 Gy: 3%; 60 a 69Gy: 14%; 70 Gy: 22%) (p < 0,001). Todos os sistemas de estadiamento foram significativos na análise da sobrevida (p < 0,001) e na população estudada, destacaram-se o TANIS 3, Hart e Berg. A resposta ao tratamento foi melhor nos tumores do palato mole e exofíticos (p =0,022). A análise multivariada mostrou como fatores independentes: o índice de Zubrod, o estádio de gravidade dos sintomas de Pugliano, a presença de comorbidades, o estadiamento de Berg e a dose da radioterapia. Observou-se que a combinação de fatores clínicos, tais como sintomatologia, estado geral, emagrecimento e comorbidades, resulta num estádio de gravidade clínica de grande relevância, podendo ser associada aos dados morfológicos do TNM, para uma melhor avaliação do prognóstico do carcinoma da orofaringe
Title in English
Analysis of clinical and histopathological prognostic factors in patients with oropharynx squamous carcinoma submitted to radiotherapy alone or in combination with systemic chemotherapy
Keywords in English
Oropharyngeal carcinoma
Prognostic factors
Staging
Abstract in English
The size of a tumor is the most important anatomic factor for assessing the prognosis and planning the treatment of head and neck tumors.. In addition to TNM, other factors contribute to the assessment of the prognosis, such as symptoms, comorbidities, macroscopic and microscopic features of the tumor, among others. The objective of this study was to identify demographic, clinical, tumoral and histopathological prognostic factors associated with patient survival and treatment response. We reviewed 361 medical records of patients with oropharynx squamous carcinoma, admitted to the Hospital A. C. Camargo and Hospital Erasto Gaertner, submitted to radiotherapy alone or in combination with chemotherapy, from 1990 to 2001. Among the variables we studied, the severity of the symptoms was assessed according to Piccirillos and Puglianos staging systems. We also analyzed the staging systems developed by Berg, TANIS 3, TANIS 4, Hart, Kiricuta and Hall, which are TNM modifications based upon the regrouping of the T and N categories, aiming to improve the prognosis assessment. As for the statistical analysis, we used the Kaplan-Meier method and Cox model. The main results were the following: most tumors were sited at the tonsil (47%) or base of the tongue (28%), at clinical stage III (13%) or IV (80%). Radiotherapy alone was used in 73% of the cases. Treatment response was achieved by 65% of the patients, mortality was seen in 80% of the cases. The average follow-up time was of 24 months, and the significant variables in the assessment of overall survival, which was of 17.6 % at 5 years, were the following: age in years ( 45: 13%; 46 55: 23%; 56 65: 19%; 66 75: 12%; > 75: 7%) (p = 0.0425); Zubrod scale (1: 24%; 2: 8%; 3: 0%) (p < 0.001); weight loss (present: 13%; absent: 29%) (p = 0.0022); comorbidities (present: 11%; absent: 26%) (p = 0.0006); Piccirillos staging (local: 31%; extra-local: 15%; regional: 14%) (p< 0.001); Puglianos staging (none: 44%; mild: 15%; moderate: 13%; severe: 12%) (p < 0.001); involvement of soft areas (absent: 21%; carotid area: 4%; masticatory area: 0%) (p < 0.001); lymph node mobility (movable: 15%; semifixed: 12%; fixed: 6%) (p = 0.03); RT doses (< 60 Gy: 3%; 60 a 69Gy: 14%; 70 Gy: 22%) (p < 0,001). All the staging systems were significant for survival analysis (p < 0.001), and the ones that stood out were TANIS 3, Hart and Berg. Treatment response was better in the soft palate and exophytic tumors (p = 0.022). The multivariate analysis showed, as independent factors, the Zubrod scale, Puglianos clinical severity staging system, comorbidities, Bergs staging and the radiotherapy dose. We have come to the conclusion that the combination of clinical factors, such as symptomatology, the patients general condition, weight loss and comorbidities, leads to a highly relevant stage of clinical severity. As far as the prognosis assessment of oropharynx carcinoma is concerned, such factors may be associated with the TNM morphological features
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Paolapedruzzi.pdf (800.42 Kbytes)
Publishing Date
2009-03-19
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
Centro de Informática de São Carlos
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2021. All rights reserved.