To determine the molecular pathways of head and neck squamous cell carcinoma (HNSCC) tumorogenesis there are held a great amount of investigations. New therapeutic models for HNSCC are discussed considering genetic and biochemical specifications and taking in account significant scientific strategies. Dividing HNSCC into 2 large groups in accordance to human papilloma virus (HPV) association with different survival rates is a great achievement of the last decades in carcinogenesis researching and treatment of HNSCC. It is well known that chemical carcinogens are the main cause of HPV-negative tumors development. HPV-positive HNSCC is associated with E6 and E7 HPV proteins. The results of whole exome sequencing of HNSCC are of the great interest. Molecular expression profile of Rb-E2F/p53 were diff erent in HPV-positive and HPV-negative tumors. The phosphorylated pRb and p16 proteins analysis showed low pRb and high p16 levels in HPV-positive tumors in contrast to HPV-negative samples due to the HPV E7 ability to degrade Rb. P16 expression was higher in HPV-positive tumors, so it is immunohystochemical marker of HPV-positive status. The p53 expression pattern is determined also to identify its mechanism of degradation in HPV-positive tumors. Due to carcinogenic HPV ability by inactivation of cell cycle regulators р53 and pRb with the help of E6 and E7 oncoproteins, mutations of TP 53 shouldn’t play leading role in HPV-induced tomorogenity. Nevertheless, there are controversial data concerning HPV-positive tumors that part of them gain p53-mutations at the same time having integrated HPV-genome. The p53 expression in HPV-positive samples was the same as if in the absence of HPV.
Aim: Stages III A and III B (with invaded mediastinal lymph nodes) are considered to be an contraindication to surgery. This group of patients with mediastinal lesions is inhomogeneous, that is why their treatment scheme should be selected individually and surgery with systematic bilateral mediastinal lymphodissection is its basis. Materials and Methods: Since 1991 to December 2006, 158 patients with NSCLC and mediastinal lymph nodes involvement had been randomized for the study of 6450 operated on patients for lung cancer. All of them underwent systematic bilateral mediastinal lymphodissection via thoracotomic (T, 81 cases) and sternotomic (S, 77 cases) approaches. Mean age was 60,5 years. Nine patients (5.6%) were found to have stage cTIIIb. Pneumonectomy was performed in 71% (112 patients), in other cases we performed lobe-and bilobectomies. Minimal follow-up was 3 months. Results: Postoperatively Stage pTIIIb was found in 27 (17%) cases -in 6 patients operated on via thoracotomy (7,4%), and in 21 patients operated on via sternotomy (27%) (s.d.). Postoperative complications were found in 8,6% patients in group T and in 7.7% patients in group S (n.s.). Mortality rate was 2,3% è 2,6% (n.s.). Five-year survival rate for N2 was 14% (T) versus 28% (S) -s.d. Five-year survival rate for N3 (Ò) was nil, and for group S -10%. Conclusions: Systematic bilateral lymphodissection does not worsen immediate results of surgical treatment. It enables to make an accurate staging and select an optimal mode of the further treatment which results in reliably increased life-span in patients with invaded mediastinal lymph nodes.
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