Distribuição espacial da mortalidade por câncer de cabeça e pescoço no Estado Espírito Santo e indicadores de prognóstico

Abstract

Knowledge about cancer mortality and evolution allows crucial tools for regional cancer control programs, and studies of molecular biomarkers are essential in the prognosis of patients with head and neck cancer (CCP). The expression of p53 protein in tumors may presume an advanced stage or metastasis, leading to a greater relevance of this biomarker for oral squamous cell carcinoma (CEO). The aim of this study was to investigate the mortality rate of head and neck cancer in its epidemiological, spatial and temporal aspects in the state of Espírito Santo, as well as to investigate the expression of p53 protein in oral squamous cell carcinoma, its relationship with clinical, pathological, histopathological and its potential use as a prognostic biomarker. Data were collected from 1998 to 2017, of deaths confirmed by head and neck cancer, with data obtained by the Department of Informatics of the Unified Health System (DATASUS, Brazil) in the state of Espírito Santo, as well as cases of squamous cell carcinoma presentation of a multicenter study from Brazil and the United Kingdom in the period 2010-2017. This is an ecological exploratory study of mortality rates due to head and neck cancer, using linear regression analysis, in which the independent variable was the year of death. The models were adjusted for selected variables, and rates standardized by state micro-region distributed spatially. The prospective longitudinal study with histological slides obtained from 95 cases of oral squamous cell carcinoma with the construction of tissue microarray (TMA) from three distinct regions: epithelium adjacent to the tumor, dysplasia and tumor, and submitted to immunohistochemistry to investigate p53 expression . For linear regression analysis, the average annual percentage (AAPC) of mortality of cases with PCC, used from the jointpoint software, was used to ascertain the expression of p53 considering the nuclear marking in keratinocytes through H-Score. The level of significance considered for all statistical tests was 95%. Chi-square test was used to establish associations between the clinicopathological variables studied in the expression of the protein. Of the results obtained, 85% of the mortality from head and neck cancer in the studied period was in men, with an increase in the trend being observed in all regional health regions of the State, in addition to the values of the oral cavity sites (APPC 1 , 1% per year), oropharynx (APPC 4.7% per year), and larynx (APPC 2.6% per year). Among women, the increase was in the central region of the state and in the oral cavity (APPC 6.6% per year). Regarding the expression of p53 in the oral cavity, there was significance between the expression and the invasion pattern (p = 0.046). Among the investigation of mortality rates in the state of Espírito Santo in males, we observed significance in the variables age group from 40 to 59 and 60 years and over, in the health regions: Central, Metropolitan, North, South and in the topographies of the oral cavity , oropharynx and larynx. In relation to females, the Central health region and the topography of the oral cavity showed significance. Rates may be related to distinction in socioeconomic and sociodemographic aspects. Enabling action strategies to combat CCP in the state. In the investigation of p53 protein expression, there was a significant association with the invasion pattern, showing an important participation in the early stages of tumorigenesis. However, no association was observed with other clinipathological and histopathological aspects, showing that the p53 protein and its application as a biomarker was not supported.