[Second carcinomas in cancers of the mouth cavity, pharynx and larynx. Clinical, histopathologic and cell kinetic findings].
BACKGROUND
The mortality because of malicious tumours of the oral cavity, of the pharynx and of the larynx has considerably increased in the Federal Republic of Germany during the last two decades. The prognosis not only shows a high ratio of recidivations and formation of metastases, but also a typical field canceration. There is a high rate of incidence of multiple primary, resp. secondary tumours that may occur synchronously or metachronously. Up to now we have learnt only little about the mechanisms concerning the development of tumours and their spread on the cellular molecular level.


METHODS
The subject of the present retrospective study was the analysis of patients suffering from an epithelioma of the oral cavity, the pharynx and the larynx and the following secondary carcinomatas. The control group were patients suffering from primary tumours of the same location and subsequent recidivation or metachronous metastasis. By determination of the degree of malignity and keratinisation of the DNA ploidy, of the immunohistological expression of p53 and the immunohistological proliferation marker MIB1 conclusions had to be drawn with regard to the biological behaviour of tumours.


RESULTS
The evaluation of the clinical parameters of the 122 patients on the whole revealed a clear increase of new disease as well as a shifting to the younger age within the last five years. Surprisingly, most common were secondary tumours in case of larynx carcinomatas. Patients suffering from secondary tumours show a bad prognosis, however, their maximum survival does not differ considerably from that of patients suffering from recidivations, resp. metastases. Because of the early diagnosis of the secondary carcinomatas the prognosis will depend on the primary carcinoma in most of the cases. The prognosis data indicate that independently from the fact whether there is a primary or a subsequent tumour, the therapy to be applied can only be a combined therapy consisting of operation and ray-therapy. The present examinations confirm reports with regard to disturbance of the p53 regulation that also play an important role in case of the head-neck area. The parallel analysis of MIB1 as a proliferation marker showed in case of the primary carcinomatas a correlation of positive p53-immunocolour with moderate and strong proliferation. Tumours in the hypopharynx and larynx showed a significantly smaller proliferation than that of the oral cavity and oropharynx. In case of the primary and secondary tumours the proliferation is more common in case of the G3-tumours.


CONCLUSIONS
The in total modest differences between the primary and secondary carcinoma with regard to the DNA-ploidy; the proliferation and the p53-expression presumably originate in their formation within the scope of a so-called field canceration. Because of the field canceration supposed for the mucous membranes of the upper aerodigestive tract, the check-ups of these patients performed in regular intervals must not be limited in any case to the area of the primary tumour. They will have to consider the entire visible area of the upper respiratory and esophageal tract.
Esser
D
D
HNO-Klinik der Klinikum Erfurt GmbH.
Anke
S
S
Roessner
A
A
Freigang
B
B
D000328:Adult; D000368:Aged; D034961:Antigens, Nuclear; D014408:Biomarkers, Tumor / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D002455:Cell Division / Q000502:physiology*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D007830:Larynx / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000473:pathology; D009687:Nuclear Proteins / Q000032:analysis; D010610:Pharyngeal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010614:Pharynx / Q000473:pathology; D011003:Ploidies; D012189:Retrospective Studies; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D034961:Antigens, Nuclear; D014408:Biomarkers, Tumor; D009687:Nuclear Proteins; D016159:Tumor Suppressor Protein p53