Rácio de gânglios linfáticos: valor prognóstico no cancro da laringe após laringectomia total
DOI:
https://doi.org/10.34631/sporl.2189Palavras-chave:
Rácio de gânglios linfáticos, Cancro da laringe, Fator Prognóstico, Esvaziamento Ganglionar CervicalResumo
Objetivo: Avaliar o Rácio de gânglios linfáticos (RGL) como preditor de sobrevida e recidiva de cancro da laringe com metastização cervical (pN+).
Desenho do estudo: Estudo retrospetivo, que incluiu doentes submetidos a laringectomia total associada a esvaziamento ganglionar cervical bilateral, entre outubro/2010 e abril/2023.
Resultados: Foram incluídos 73 doentes. Entre os doentes pN+ (n=37;50,7%), aqueles com evidência de recidiva tumoral (n=16;43,2%) apresentaram uma mediana de RGL superior (0,159 versus 0.060), p=0,007. Após análise da curva ROC, o RGL>0,063 indicou recidiva tumoral (sensibilidade:87%; especificidade:48%). Para além disso, o RGL>0,063 manteve-se como um preditor independente de recidiva tumoral, após análise multivariada ajustada para potenciais fatores de confundimento (idade, extensão extraganglionar, margem de resseção e estadio patológico T),(HR=6,58; p=0,049). Por último, um RGL elevado (>0,063) esteve associado à morte específica por cancro em doentes pN+ (OR=8,64; p=0,008).
Conclusão: Este estudo indica que doentes com RGL>0,063 têm maior probabilidade de doença agressiva. Assim, o RGL é um parâmetro prognóstico relevante, podendo ser útil para complementar o estadiamento TNM no cancro da laringe pN+.
Referências
Audet N, Beasley NJ, MacMillan C, Jackson DG, Gullane PJ, Kamel-Reid S. Lymphatic vessel density, nodal metastases, and prognosis in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2005 Dec;131(12):1065-70. doi: 10.1001/archotol.131.12.1065.
Cerezo L, Millán I, Torre A, Aragón G, Otero J. Prognostic factors for survival and tumor control in cervical lymph node metastases from head and neck cancer. A multivariate study of 492 cases. Cancer. 1992 Mar 1;69(5):1224-34. doi: 10.1002/cncr.2820690526.
Vishal Rao US, Shetty SS, Kudpaje A, Rao GA, Kunigal SS. (i) TNM staging for head and neck cancers. Oral Oncol. 2019 Oct:97:133-134. doi: 10.1016/j.oraloncology.2019.08.016.
Brierley JD, Gospodarowicz MK, Wittekind C, editors. TNM Classification of Malignant Tumours, 8th ed. Wiley; 2017.
Künzel J, Mantsopoulos K, Psychogios G, Agaimy A, Grundtner P, Koch M. et al. Lymph node ratio is of limited value for the decision-making process in the treatment of patients with laryngeal cancer. Eur Arch Otorhinolaryngol. 2015 Feb;272(2):453-61. doi: 10.1007/s00405-014-2997-3.
Wiznia LE, Lannin DR, Evans SB, Hofstatter EW, Horowitz NR, Killelea BK. et al. The number of lymph nodes dissected in breast cancer patients influences the accuracy of prognosis. Ann Surg Oncol. 2014 Feb;21(2):389-94. doi: 10.1245/s10434-013-3308-8.
Ergenç M, Uprak TK, Akın Mİ, Hekimoğlu EE, Çelikel ÇA, Yeğen C. Prognostic significance of metastatic lymph node ratio in gastric cancer: a Western-center analysis. BMC Surg. 2023 Aug 7;23(1):220. doi: 10.1186/s12893-023-02127-y.
Kitamura Y, Oshikiri T, Takiguchi G, Urakawa N, Hasegawa H, Yamamoto M. et al. Impact of lymph node ratio on survival outcome in esophageal squamous cell carcinoma after minimally invasive esophagectomy. Ann Surg Oncol. 2021 Aug;28(8):4519-4528. doi: 10.1245/s10434-020-09451-0.
Talmi YP, Takes RP, Alon EE, Nixon IJ, López F, de Bree R. et al. Prognostic value of lymph node ratio in head and neck squamous cell carcinoma. Head Neck. 2018 May;40(5):1082-1090. doi: 10.1002/hed.25080.
Abdeyrim A, He S, Zhang Y, Mamtali G, Asla A, Yusup M. et al. Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg. 2020 May 29;49(1):31. doi: 10.1186/s40463-020-00421-w.
Patel SG, Lydiatt WM. Staging of head and neck cancers: is it time to change the balance between the ideal and the practical? J Surg Oncol. 2008 Jun 15;97(8):653-7. doi: 10.1002/jso.21021.
Shah JP, Montero PH. New AJCC/UICC staging system for head and neck, and thyroid cancer. Rev. Med. Clin. Condes. 2018; 29(4): 397-404. doi.org/10.1016/j.rmclc.2018.07.002
Redaelli de Zinis LO, Nicolai P, Barezzani MG, Tomenzoli D, Antonelli AR. Incidence and distribution of lymph node metastases in supraglottic squamous cell carcinoma: therapeutic implications. Acta Otorhinolaryngol Ital. 1994;14(1):19-27.
Tomik J, Składzien J, Modrzejewski M. Evaluation of cervical lymph node metastasis of 1400 patients with cancer of the larynx. Auris Nasus Larynx. 2001 Aug;28(3):233-40. doi: 10.1016/s0385-8146(00)00116-4.
Sabaa MAE, El Batawi AM. Factors favoring neck metastasis in patients underwent laryngectomy for laryngeal cancer. The Egyptian Journal of Otolaryngology 2021;37(1):96. doi.org/10.1186/s43163-021-00160-3
Lin Z, Lin H, Chen Y, Xu Y, Chen X, Fan H, et al. Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma. J Cancer. 2021 Jan 1;12(4):1220-1230. doi: 10.7150/jca.50404.
Wang YL, Li DS, Wang Y, Wang ZY, Ji QH. Lymph node ratio for postoperative staging of laryngeal squamous cell carcinoma with lymph node metastasis. PLoS One. 2014 Jan 27;9(1):e87037. doi: 10.1371/journal.pone.0087037.
Petrarolha S, Dedivitis R, Matos L, Ramos D, Kulcsar M. Lymph node density as a predictive factor for worse outcomes in laryngeal cancer. Eur Arch Otorhinolaryngol. 2020 Mar;277(3):833-840. doi: 10.1007/s00405-020-05789-z.
Reinisch S, Kruse A, Bredell M, Lübbers HT, Gander T, Lanzer M. Is lymph-node ratio a superior predictor than lymph node status for recurrence-free and overall survival in patients with head and neck squamous cell carcinoma? Ann Surg Oncol. 2014 Jun;21(6):1912-8. doi: 10.1245/s10434-014-3634-5
Lugo-Cintrón KM, Ayuso JM, Humayun M, Gong MM, Kerr SC, Ponik SM. et al. Primary head and neck tumour-derived fibroblasts promote lymphangiogenesis in a lymphatic organotypic co-culture model. EBioMedicine. 2021 Nov:73:103634. doi: 10.1016/j.ebiom.2021.103634.
Abakay MA, Güneş S, Gülüstan F. Prognostic importance of harvested lymph node number, metastatic lymph node number, and lymph node ratio in surgically managed laryngeal squamous cell carcinoma. Braz J Otorhinolaryngol. 2021 Jul-Aug;87(4):416-421. doi: 10.1016/j.bjorl.2020.07.012.
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Direitos de Autor (c) 2024 Revista Portuguesa de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço
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