口腔へん平上皮癌の初回治療後，３年以上を経て局所に再発した症例の臨床病理学的検討

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  • Clinico-pathological evaluation of late recurrence of oral squamous cell carcinomas.

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Among 221 patients with primary oral SCCs, 18 (8.1%) had late recurrence at the primary site from 36 to 175 months after the initial treatment. Late recurrence of oral carcinomas was evaluated clinicopathologically, and the following results were obtained:<BR>1) Late recurrence occurred at a significantly higher incidence in T 1 tumors than T 2-4 tumors.<BR>2) As for the clinical growth pattern, superficial type primary tumors were more likely to have late recurrence than exophytic or endophytic type (p>0.05).<BR>3) There was no difference in late recurrence rate between patients who received chemotherapy and those who received no chemotherapy. Among 69 patients who received radiation, radiation-induced oral carcinoma occurred in 1 patient (1.4%), 11 years after radiotherapy.<BR>4) Histopathologically, the degree of differentiation and mode of invasion, were similar for primary and recurrent lesions.<BR>5) Late recurrence occurred in tumors associated with epithelial dysplasia (13/71 cases, 18.3%) at a significantly higher rate than those lacking epithelial dysplasia (3 /105 cases, 2.9%). Epithelial dysplasia adjacent to carcinoma was also observes in 93.8% of primary lesions with late recurrence.<BR>6) Margin status was an important factor affecting lacal recurrence rate but not late recurrence rate.<BR>7) Among the 18 primary tumors with late recurrence, tumor suppressor gene, p53, was detected in 50% of primary carcinomas, 26.7% of dysplasia, and 11.1% of normal epithelium.<BR>These results suggest that late recurrence is a de novo carcinoma caused by field cancerization. Epithelial dysplasia adjacent to cancer is an important factor in predicting late recurrence of oral carcinomas. Thus, long-term follow-up is necessary for such patients, even when primary tumors are small and completely resected.

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