Fogorvosi szemle, 2007 (100. évfolyam, 1-6. szám)

2007-10-01 / 5. szám

255

FOGORVOSI SZEMLE ■ 100. évf. 5. sz. 2007.

Epidemiological correlations of DM2 and oral cancer progression

Although DM2 and cancer are major health problems affecting the adult population in western countries, few studies have directly addressed the relationship between the two diseases or the impact of DM2 on cancer outcome [36, 48], The question arose as to what extent could the metabolic disturbance of DM2 influence the progression of OC.

Our study was a prospective comparative examination involving a homogeneous control group, to determine the rate of progression of cancers of the oral cavity in patients with DM and in patients with a normal glucose metabolism [61].

Prospective follow-up studies involved patients with gingival squamous cell carcinoma in stage T2-3N0M0. Their treatment comprised surgical tumor extirpation,

was 24:24 in the type-2 diabetes group, and 27:25 in the control group.

A total of 33% of the type-2 diabetes group and 69% of the control group were active smokers; 21% of the type-2 diabetes group and 1% of the control group had smoked previously.

In the DM2 group, progression was observed in 30 of the 48 cases (62.5%); 6 cases involved local recurrence (20%), and 24 cases involved both local recurrence and cervical lymph node metastases (80%). By the end of the 2-year follow-up period, 24 of the 48 patients (50%) had died (Table III.).

In the control group, 24 of the 52 patients displayed cancer progression (46.1%): 14 cases suffered of local recurrences (58%), and 10 (42%) some other form of progression, 6 of which involved the joint occurrence of local recurrence and lymph node metastases, whereas in 2 cases there were only regional lymph node

Table III:

Distribution of progression events in the DM2 group and the control group after a 2-year follow-up period

Progression

DM2 group (n=48)

Control group (n=52)

Rate of tumor progression

30 (62.5%)

24 (46.1%)

Local recurrence

6 (20%)

14 (58%)

Local recurrence + regional metastases

24 (80%)

6 (25%)

Local recurrence + regional metastases + lung metastases-2 (8%)

Regional metastases-2 (8%)

Rate of death

24 (50%)

6(11%)

block resection of the mandible, functional cervical dissection and 60 Gy of adjuvant irradiation. The patients were divided into a group with DM2 and a non-diabetic, control group. Cancer progression data were recorded after a 2-year period of clinical follow-up. Surgical samples were assessed histopathologically from the aspect of local and metastatic tumor spread [64],

metastases. In 2 cases there was a combination of local recurrence, cervical and pulmonary metastases. During the 2-year follow-up period, 6 of the 52 patients (11%) died (Table III.).

Between the two groups, the differences were significant when the proportions of metastases and death were considered. There were significantly more meta-Table IV.

Histological degree of tumor invasion in the DM2 and control groups

Degree of tumor invasion

DM2 group (n=48)

Control group (n=52)

1.

4 (8%)

10(19%)

2.

10 (21%)

27 (52%)

3.

14 (29%)

9 (17%)

4.

20 (42%)

6 (12%)

Results of the clinical examinations. The randomized prospective study included 100 cancer patients: 48 were allocated to the type-2 diabetes group, and 52 to the control group. The mean age of the patients in the type-2 diabetes group was 55.8 years, while that in the control group was 57.0 years. The male-female ratio

static cases (p<.05) and deaths during the 2-year follow-up (p<.001) in the type-2 diabetes group.

Histopathological results. Among the gingival cancer cases with type-2 diabetes grade-3 and grade-4 tumor invasion occurred more frequently: in 34 of the 48 cases (70.1%), whereas grade-1 and grade-2 invasion