Published in Cancer Detection and Prevention 2000; 24(Supplement 1).

Cancer of the tongue: the role of apoptotic vs necrotic and proliferative tumor markers as related to clinical and prognostic characteristics

RM Nagler MD MSc PhD 1,2, D Laufer MD 1, O Ben-Itzhak MD 3

1 Dept Oral and Maxillofacial Surgery,, 2 Oral Biochemistry Laboratory,, 3 Dept Pathology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel,

AIM: The Department of Oral and Maxillofacial Surgery at Rambam Medical Center in Haifa is the major oncological facility for the treatment of oral squamous cell carcinoma [SCC] in northern Israel. This enables us to evaluate 90 patients who suffered from tongue SCC. METHODS: The diagnostic and prognostic roles of tissue tumorigenic (erb, bcl-2 and p-53) and apoptotic (tunnel) markers in these malignancies were analyzed in relation to the demographic, clinical, disease and therapeutic characteristics of the malignancies. RESULTS: SCC comprises 93.7% of all lingual malignancies diagnosed and treated. The mean age of patients was 63.4*1.6 years. The number of women with disease was relatively high [43%] and most of the patients [73%] were European-American Ashkenazi Jews. Thirty percent of patients had symptomatology prior to diagnosis [pain, soreness, lingual motility limitation, etc.]. Most patients were diagnosed at early stages of the disease [72% Stages I-II] with lower histological grades [95% grades 1-2]. The overall 5-year survival probability was relatively high - 61%. Most patients [76%] were treated with local surgery, with/without adjuvant tele-radiotherapy. Radiotherapy did not alter the survival probability achieved by local surgery for Stage I patients. However, it significantly and profoundly improved survival for Stage II patients; the 5-year probability of survival following combined treatment was 72% as compared to 14% following local surgery alone [p=0.023]. Young patients had a lower probability of survival as compared to older ones [40% vs 65%, NS]. One of the most interesting observations was that salvage treatment administered to patients with recurrences was useful in only 15% of cases. CONCLUSION: Our results emphasize the crucial importance of the primary treatment - the 'first shot' - in saving tongue cancer patients.

KEY WORDS: Tongue, Cancer, Tumor markers, Radiotherapy, Surgery.

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Paper presented at the International Symposium on Impact of Biotechnology on Cancer Diagnostic & Prognostic Indicators; Geneva, Switzerland; October 28 - 31, 2000; in the section on prognostic markers.