Интегративная стоматология и челюстно-лицевая хирургия Ҷилди 5 № 2 (2026) · Саҳифаҳои 159-164
Clinical and immunological examinations for locally advanced oral and oropharyngeal cancer
Ганиев А.А., Ганиев А.К., Жураев Б.Н.
Аннотатсия
Introduction. In the Russian Federation, cancer of the oral cavity and oropharynx ranks second in incidence among head and neck tumors. Patients who consult an oncologist for this pathology typically present with an advanced tumor process, already at Stage III-IV. The mortality rate for these patients is 30–40% within the first year after treatment. This underscores the need to improve diagnostic and therapeutic methods for this disease using evidence-based clinical approaches. Modern laboratory methods, which allow for predicting a patient's condition before and during treatment, have been introduced into clinical practice to facilitate successful therapeutic adjustments. Significant attention is given to evaluating the practical experience of relevant medical institutions.Objective. To develop a modern algorithm for the diagnosis and treatment of patients with oral cavity and oropharyngeal cancer, utilizing the experience of specialized medical institutions at the Tashkent Regional Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology (RSSPMCOR).Materials and Methods. The study included 42 patients with oral cavity and oropharyngeal cancer who were treated at the Department of Head and Neck Tumors of the RSSPMCOR between 2017 and 2025. Of these, 27 patients had Stage III disease (T1-3N0-1), 7 patients had Stage IV disease (T4N0-1), and 8 patients presented with widespread recurrence. Prior to surgery, all patients received neoadjuvant radiation therapy (40 Gy). The surgical interventions involved radical removal of the primary tumor and, in the presence of neck metastases, simultaneous cervical lymph node dissection at levels IB, IIA-B, III, and VA. During surgery, tissue samples were collected from the tumor and the peritumoral area. These samples were homogenized, and the levels of pro- and anti-inflammatory cytokines were determined, including interleukins (IL) 1β, 6, 8, and 10; interleukin-1 receptor antagonist (IL-1RA); interferons (IFN) α and γ; tumor necrosis factor (TNF) α; and secretory immunoglobulin A (sIgA).Results. In the group of primary patients without regional metastases, the level of pro-inflammatory cytokines was found to be statistically significantly higher in the tumor tissue compared to the peritumoral area. Similar differences were observed in patients with regional metastases. In cases of recurrence, such a difference was noted only for the level of interleukin-6. It is noteworthy that with recurrences, the differences in IL-1β, IL-6, and IL-8 levels, which were pronounced in the other two groups, disappeared in both tumor and peritumoral tissue samples. This suggests that the immunologically non-malignant-appearing tissue approaches the immunological properties of the tumor tissue, which may indirectly indicate a loss of its properties that limit proliferative potential. In the peritumoral area, differences were identified for two indicators: the levels of TNF-α and IL-1β were higher in recurrences compared to primary tumors without regional metastases. No differences in the tissue-specific content of secretory immunoglobulin A were observed between the tumor and the peritumoral area in patients with and without metastases. However, in patients with recurrences, higher levels were observed in the tumor tissue compared to the peritumoral area. In tissue samples from this same group (recurrences), the sIgA level was statistically significantly higher than in the group with metastases, where its level was the lowest among all studied groups, indicating a decrease in its local synthesis. In the peritumoral areas, this indicator was statistically consistent across all groups.Conclusions. 1. Clinical data, in conjunction with immunological markers, should be used to supplement the objective assessment of the condition of patients with oropharyngeal cancer. 2. High levels of pro-inflammatory cytokines in tumor tissues contribute to tumor development and progression, which may be a result of both their production by tumor cells and the local inflammatory process; cytokine levels in tumor tissues exceed their levels in the peritumoral area. 3. The level of secretory immunoglobulin A is lowest in metastasizing tumor tissue and highest in recurrent tumor tissue. However, no statistically significant differences were noted.
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