Sistemas de gradação histopatológica de malçignidade e sua relação com parâmetros clínicos em carcinomas de células escamosas de lábio inferior

Abstract

Squamous cell carcinoma is the most common malignant neoplasm in lower lip. The clinical staging system for tumors (TNM) is an international system for staging malignant neoplasms that has been used to estimate both the clinical response to therapy and patients survival. However, this system does not always predict clinical outcome for patients, a fact that has driven the search for other prognostic factors that could improve it, particularly the histopathologic malignancy grading systems (HMGS). The aim of this study was to evaluate the histopathologic grade of malignancy in a case series of lower lip squamous cell carcinomas (LLSCC), by means of malignancy grading of the deep invasive front (BRYNE et al., 1992), World Health Organization (WHO) grading system (CARDESA et al., 2005) and histopathologic risk assessment (BRANDWEIN-GENSLER et al., 2005), relating it to clinical aspects. Tissue sections stained with hematoxylin and eosin, obtained from 59 cases of LLSCC, were examined under a light microscope. Chi-square test and Fisher s exact test were performed to verify possible associations between the histopathologic grade of malignancy of the tumors and clinical aspects (size/ direct extension of the tumor, regional nodal metastasis, and clinical stage). Regarding the histopathologic grading at the invasive front, the low grade of malignancy showed a significant association with absence of regional metastasis (p = 0.030) and early clinical stage (p = 0.043). On the other hand, the high grade of malignancy at the invasive front disclosed a significant association with the larger size/ direct extension of the tumor (p = 0.040). With respect to WHO grading system, no statistically significant associations were observed between the clinical aspects and the histopathologic grade of the tumors (p > 0.05). For histopathologic risk assessment, the risk score showed a highly significant association with regional nodal metastasis (p = 0.004) and clinical stage (p = 0.002). In addition, the lymphocytic infiltrate exhibited a significant association with regional metastasis (p = 0.017) and clinical stage (p = 0.040). In conclusion, the results of the present study suggest that, of the HMGS evaluated, the histopathologic risk assessment may constitute the best system to indicate the biological behavior of LLSCC.