[Lymph node metastases in paranasal sinus carcinoma: prognostic value and treatment]. / Metastasi linfonodali nei carcinomi dei seni paranasali: valore prognostico e trattamento.

The purpose of this report is to assess, on the basis of a sizeable study, the prognostic value of lymph node metastases in paranasal sinus carcinoma and, in particular, in squamous cell carcinoma of the maxillary sinus. We have reviewed the charts of 601 cases of paranasal sinus carcinoma between 1970 and 1999. All of the patients were treated surgically, alone or associated with chemotherapy and/or radiotherapy. The maxillary sinus tumors numbered 379 (153 squamous cell carcinomas, 15 undifferentiated carcinomas, 94 adenoid cystic carcinomas, 19 adenocarcinomas, 98 mesenchymal tumors and rare forms) and the ethmoidal tumors were 222 (117 adenocarcinomas, 27 squamous cell carcinomas, 16 adenoid cystic carcinomas, 13 undifferentiated carcinomas, 49 other histological forms). Lymph node metastases in ethmoidal tumors were rare, with the exception of undifferentiated carcinoma (46.1%). The percentages of metastatic squamous cell carcinoma of the maxillary sinus upon presentation were: T2 15.5%, T3 7%, and T4 4%. All these patients underwent lymph node excision. The metastases successive to treatment of the primary tumor were: T2 16.9%, T3 8.8%, and T4 12%. 75% of these late metastases occurred contemporaneously with a recurrence of T and only 5 (25%) constituted the single reawakening of disease; four of these patients underwent neck surgery and were cured operatively. One had fixed, inoperable metastases. The NED survival rate at least two years after T therapy in patients free from metastases was 50.4%, against 25% in those with initial or distant metastases (T2 72.9% vs. 30.4%, T3 37.5% vs. 22.2%, and T4 28.6% vs. 0%). In conclusion, squamous cell carcinomas of the maxillary sinus which have extended to the oral cavity (T2) show greater lymph node propagation than those of the superoposterior portion (T3-T4). The presence or successive appearance of lymph node metastases indicates elevated malignancy of the tumor, with a very negative prognosis. N, however, is rarely the cause of death for these patients. Prophylactic lymph node excision in N0 patients is therefore not indicated.

Prognostic factors in head and neck oncology: a critical appraisal for use in clinical practice.

BACKGROUND: An ideal prognostic factor would provide information about the biological behaviour of a tumour, permitting the prediction of the outcome and response to therapy. Nowadays there is a considerable confusion concerning the value, significance and use of the know prognostic factors in head and neck cancer. MATERIAL AND METHODS: A meta-analysis of works published in literature between 1993 and August 1997 on prognostic factors in head and neck oncology was carried out. RESULTS: Prognostic factors were analysed and classified according to Wennenberg in the following groups: patient-related factors, tumour-related factors and factors predicting response to therapy. CONCLUSIONS: We propose a classification of prognostic factors in head and neck cancer according to their significance and reliability: factors of proven significance and experimental factors. This classification might be useful to select guidelines to use in clinical practice.

Analysis of prognostic factors and proposal of a new classification for nasopharyngeal cancer.

A retrospective analysis was performed on 410 patients with nasopharyngeal carcinoma of squamous or undifferentiated histotype. All patients were classified according to the classification of the American Joint Committee for Cancer Staging and End-Results Reporting (AJC) and to that of the International Union Against Cancer (UICC, Geneva, 1978). The following prognostic factors were investigated by means of a Weibull multiple regression model: sex, age, histology, primary tumor extent, and nodal metastasis extent. With the exception of sex, all factors significantly influenced survival. With regards to nodal extent, only the level of the involved nodes was a significant variable. Both AJC and UICC classifications, when applied to the entire series of patients, appeared to be unsatisfactory. The authors propose an alternative classification based on a prognostic scoring system directly derived from the Weibull model.

Presence of activated T-cells with a T8+ M1+ Leu 7+ surface phenotype in invaded lymph nodes from patients with solid tumors.

The lymphocyte surface phenotype of lymph nodes from patients with larynx or urinary bladder carcinoma was investigated by using a panel of monoclonal antibodies. The phenotype pattern of lymphocytes from lymph nodes invaded by malignant cells (as assessed by histopathology) was different from that of the cells from noninvaded or normal control nodes. Although the proportion of natural killer cells or macrophages was similar in the 3 groups of lymph nodes, invaded lymph nodes contained a higher proportion of T-cells and a lower B-cell percentage. Furthermore, cells from invaded nodes comprised 15-20% of T3+ T8+ cells that coexpressed the M1 marker and, to some extent, also the Leu 7 marker. A large proportion of cells with multiple markers were activated, as shown by the expression of Tac and HLA-DR antigens. In 2 patients activated T8+ cells expressing also M1 and Leu 7 markers infiltrated the tumor site. The presence of these activated cells both in involved nodes and tumor mass may indicate that they originate in response to cancer.