RESUMO
BACKGROUND: Tumor budding (TB) has been investigated in several types of solid tumors. In oral cancer, studies show its association with survival. However, for its implementation in routine histological analyses, results with a high certainty of evidence are needed. Therefore, the aim of this systematic review is to explore the association between tumor budding and overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) in oral cancer. METHODS: A search was performed in Embase, PubMed, Scopus, Livivo, Web of Science, and Google Scholar. We adopted the following inclusion criteria: studies that evaluate tumor budding in oral cancer, that investigate survival, and presenting cohort design. We excluded reviews and studies without hazard-ratio (HR) data. RESULTS: This systematic review included 22 studies and showed an association between TB and survival. High-grade TB is associated with a worse OS in univariate analysis (HR = 3.11; 95% CI: 2.06-4.69, p<0.01) and multivariate analysis (HR = 2.62; 95% CI: 1.64-4.20, p<0.01); with a poorer DSS in univariate (HR = 2.43; 95% CI: 1.94-3.03, p<0.01) and multivariate analysis (HR = 2.01; 95% CI: 1.43-2.83, p< 0.01); and with a worse DFS in univariate (HR = 1.94; 95% CI: 1.44-2.62, p<0.01) and multivariate analysis (HR = 2.15; 95% CI: 1.31-3.53, p< 0.01). Sensitivity analysis showed that the results are robust, and no significant publication bias was identified in univariate analysis for DFS (Egger's test: p = 0.94). The certainty of the evidence was graded as low or very low. CONCLUSION: Our findings indicate that TB is an independent prognostic factor of OS, DSS, and DFS in oral cancer. However, further studies are needed to increase the certainty of the evidence.
Assuntos
Neoplasias Bucais , Humanos , Intervalo Livre de Doença , Intervalo Livre de Progressão , Análise Multivariada , PubMedRESUMO
The objective of this case is to discuss the endodontic management in patient diagnosed with Progressive Ossificans Fibrodysplasia (POF) who sought the dental service due to discomfort in the mandible. Minor mobility of the peripheral joints, spinal involvement, gait limitation, inability to sit, report of joint pain, and limitation of TMJ movements were observed on the extra-oral examination. The intraoral examination revealed the presence of ectopic teeth (13 and 23), prolonged retention of primary teeth (53 and 63), dental gyrosurgery (34 and 33), caries lesion on teeth 36 and 47, and dental crowding. To the percussion test and the thermal pulp sensitivity of the tooth 36, there was no response, indicating pulp necrosis. Conventional endodontic therapy was performed under intrapulpal anesthesia and the dental chair placed at 45º. The patient evolved without painful symptomatology, is free of heterotopic ossification resulting from the treatment and her ability to open the mouth remained the same. Thus, endodontic treatment is a viable procedure and should be eligible in patients with POF because it minimizes local trauma and reduces iatrogenic risks, which may exacerbate the progression of the disease.