LUIZ PAULO KOWALSKI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Implication of the New AJCC pT Classification of SCC of the Lip Comparing With Other Oral Subsites(2021) TOLEDO, Loic Monginet; OLIVEIRA, Adriana Santos de; PINHEIRO, Renan Aguera; LEITE, Ana Kober Nogueira; MELLO, Evandro Sobroza de; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio V.; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoObjective To determine the implication of the new AJCC staging system for pT classification in a cohort of patients with SCC of the lip mucosa and compare it to other oral cavity sites. Methods Retrospective cohort of 744 patients treated between 2002 and 2017, by the Head and Neck Surgery Department of the University of Sao Paulo. Results Of 95 lip patients, 42 had pT upstage (58.1% of pT1 to pT2-3 and 50% of pT2 to pT3). Similar DFS/OS observed for those pT1 maintained or upstaged to pT2-3, pT2 patients upstaged to pT3 presented worse OS (49.4% versus 92.3%, P = .032). The comparison between lip and other mouth topographies, denoted better prognosis for pT1-2, but not for pT3-4a. Lip tumors had lower DOI, rates of perineural/angiolymphatic invasion, nodal metastasis, recurrence, and death. Conclusion The inclusion of DOI to the new pT classification better stratifies patients with SCC of the lip mucosa upstaged to pT3 by assessing inferior OS. Level of Evidence 3 Laryngoscope, 2021
- Prognostic Value of Hematological Parameters in Oral Squamous Cell Carcinoma(2023) TREVISANI, Lorenzo Fernandes Moca; KULCSAR, Isabelle Fernandes; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoIntroduction: Oral squamous cell carcinoma (OSCC) remains a significant public health concern. The variables utilized to determine appropriate treatment for this disease also represent its most unfavorable prognostic factors, with these parameters solely determined by the neoplasm and its behavior. However, a lack of well-established indices is evident in the literature that specifically relate to the patient and indicate a worse prognosis. Objective: To assess the prognostic impact of hematological indices in patients with OSCC. Methods: This retrospective cohort study included patients with oral squamous cell carcinoma (OSCC) who underwent curative-intent treatment. Treatment encompassed surgery, followed by adjuvant therapy, as necessary. Laboratory tests were conducted immediately prior to surgery, and demographic information was obtained from medical records. Results: The cohort comprised 600 patients, with 73.5% being male subjects. Adjuvant treatment was recommended for 60.3% of patients. Throughout the follow-up period, 48.8% of participants died. Univariate analysis indicated that perineural invasion, angiolymphatic invasion, pT4 tumors, lymph node metastases, extranodal extravasation, RDW > 14.3%, NLR (neutrophil-lymphocyte ratio) > 3.38, PLR (platelet-lymphocyte ratio) > 167.3, and SII (systemic inflammatory/immune response index) > 416.1 were factors associated with increased mortality. These threshold values were established through ROC curve analysis. In the multivariate analysis, angiolymphatic invasion (HR = 1.43; 95% CI: 1.076-1.925; p = 0.014), pT4a/b tumors (HR = 1.761; 95% CI: 1.327-2.337; p < 0.001), extranodal extravasation (HR = 1.420; 95% CI: 1.047-1.926; p = 0.024), and RDW (HR = 1.541; 95% CI: 1.153-2.056; p = 0.003) were identified as independent risk factors for decreased overall survival. Conclusions: RDW > 14.3% was proven to be a reliable parameter for assessing overall survival in patients with OSCC. Further studies are required to evaluate the clinical applicability of other hematological indices.
- Tumor volume as a prognostic factor of locally advanced laryngeal cancer(2021) ANDRADE, Natalia Martins Magacho de; DEDIVITIS, Rogerio Aparecido; RAMOS, Daniel Marin; MATOS, Leandro Luongo; GARCIA, Marcio Ricardo Taveira; CONTI, Gustavo Goncalves; KOWALSKI, Luiz Paulo
- Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer(2022) TREVISANI, Lorenzo Fernandes Moça; KULCSAR, Isabelle Fernandes; LEITE, Ana Kober Nogueira; KULCSAR, Marco Aurélio Vamondes; LIMA, Graziele Aparecida Simões; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoAbstract Objective: The aim of the present study was to analyze the prognostic relationship of weight loss and preoperative hematological indexes in patients surgically treated for pT4a squamous cell carcinoma of the oral cavity. Methods: A retrospective cohort study. Results: Percent weight loss greater than 10% was identified in 49 patients (28.2%), and any weight loss in relation to the usual weight occurred in 140 patients (78.7%). Percent weight loss greater than 10% (HR = 1.679), Red cell distribution width (RDW) values greater than 14.3% (HR = 2.210) and extracapsular spread (HR = 1.677) were independent variables associated with risk of death. Conclusion: Patients with advanced squamous cell carcinoma of the oral cavity present significant weight loss and as significantly immunocompromised. Increased values of RDW and higher percentages of weight loss in relation to the individual’s usual weight, together with extracapsular spread of metastatic lymph nodes, were risk factors for lower survival, regardless of other clinical and anatomopathological characteristics. Level of evidence: 3.
- Prognostic impact of perineural invasion in oral cancer: a systematic review(2022) QUINTANA, Debora Modelli Vianna Ocampo; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz PauloIntroduction. Numerous studies have evaluated the prognostic significance of perineural invasion (PNI) in oral cancer; however, the results are inconclusive. Purpose. To identify the prognostic value of PNI in oral cancer through a metanalysis. Methods. A literature review was carried out, searching the MedLine databases via Pubmed, Scielo, Lilacs, Cochrane and Websco. Results. A total of 56 studies were included. The results indicate that PNI in oral cancer has an incidence of 28% (95% confidence interval (CI) 24-31%); 5-year survival with relative risk (RR) 0.67 (0.59-0.75); 5-year disease-free survival RR 0.71 (0.68-0.75); locoregional recurrence with RR 2.09 (1.86-2.35). Conclusions. PNI is a negative prognostic factor in oral cancer.
- MicroRNA-mediated extracellular matrix remodeling in squamous cell carcinoma of the oral cavity(2021) MENDERICO JUNIOR, Gilberto Mendes; THEODORO, Therese Rachell; PASINI, Fatima Solange; ISHIKAWA, Marina de Menezes; SANTOS, Nayara Stephanie Sousa; MELLO, Evandro Sobroza de; PINHAL, Maria Aparecida da Silva; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio Aparecido; CERNEA, Claudio Roberto; KOWALSKI, Luiz Paulo; MATOS, Leandro Luongo deBackground We evaluated microRNAs and extracellular matrix component profiles in squamous cell carcinoma of the oral cavity (OSCC) in comparison to healthy mucosa. Methods Retrospective study investigating 64 microRNAs related to oncogenic process and to constituents of the extracellular matrix. We also performed immunohistochemical assays for molecules involved in the same biological processes. Results High expression of miR-21-5p (p < 0.001) and miR-106-5p (p < 0.001) and low expression of miR-320a (p = 0.001) and miR-222-3p (p = 0.001) were predictors of malignancy. Individually, miR-21-5p exhibited the best statistical performance (area under the curve = 0.972; 95% confidence interval: 0.911-1.000) in the differentiation between tumor tissue and healthy mucosa. Moreover, tumor sample showed increased expression of MMP-2, MMP-9, alpha-laminin, and beta-laminin in tumor-related fibroblasts and lower continuity of type IV collagen in the basement membrane. Conclusion The present study demonstrates the biological effects of microRNAs on the carcinogenesis of OSCC as well as the intense modification of the tumor microenvironment.
- Impact of lymph node ratio and number of lymph node metastases on survival and recurrence in laryngeal squamous cell carcinoma(2023) MOLTENI, Gabriele; NOCINI, Riccardo; MATTIOLI, Francesco; NAKAYAMA, Meijin; DEDIVITIS, Rogerio A.; MANNELLI, Giuditta; CROSETTI, Erika; CHIESA-ESTOMBA, Carlos Miguel; SISTIAGA-SUAREZ, Jon A.; GIORDANO, Leone; GALLI, Andrea; LIONELLO, Marco; MERCANTE, Giuseppe; RALLI, Massimo; FERMI, Matteo; KLEIN-RODRIGUEZ, Alejandro; MAYO-YANEZ, Miguel; SERAFINI, Edoardo; PIROLA, Francesca; PADERNO, Alberto; CAMBRIA, Francesca; ORIDATE, Nobuhiko; SANO, Daisuke; BOSCOLO-RIZZO, Paolo; MARCUZZO, Alberto Vito; PARRINELLO, Giampiero; MARCHI, Filippo; SAIBENE, Alberto Maria; TUCCIARONE, Manuel; VISCASILLAS, Guillem; ZELENIK, Karol; RAMOS, Daniel Marin; PALACIOS-GARCIA, Jose; TIRELLI, Giancarlo; PELLINI, Raul; PALUDETTI, Gaetano; GALLI, Jacopo; ROSSI, Giorgia; VINCENTIIS, Marco De; CERNEA, Claudio Roberto; SPRIANO, Giuseppe; BUSSI, Mario; PERETTI, Giorgio; SUCCO, Giovanni; PIAZZA, Cesare; BERTOLIN, Andy; KOWALSKI, Luiz Paulo; PRESUTTI, Livio; SACCHETTO, AndreaIntroductionThe aim of this study is to assess the impact of lymph node ratio (LNR) and number of positive lymph nodes (NPLN) on mortality and recurrence rates in patients with laryngeal squamous cell carcinoma. Materials and methodsWe conducted a retrospective multicenter international study involving 24 Otorhinolaryngology-Head and Neck Surgery divisions. Disease-specific survival (DSS) and disease-free survival (DFS) were evaluated as the main outcomes. The curves for DSS and DFS according to NPLN and LNR were analyzed to identify significant variations and establish specific cut-off values. Results2507 patients met the inclusion criteria. DSS and DFS were significantly different in the groups of patients stratified according to LNR and NPLN. The 5-year DSS and DFS based on LNR and NPLN demonstrated an improved ability to stratify patients when compared to pN staging. ConclusionOur data demonstrate the potential prognostic value of NPLN and LNR in laryngeal squamous cell carcinoma.
- Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers(2023) ALVARENGA, Gustavo Fernandes de; LEITE, Ana Kober Nogueira; LEHN, Carlos Neutzling; DEDIVITIS, Rogerio Aparecido; NAKAI, Marianne Yumi; CAVALHEIRO, Beatriz Godoi; TEIXEIRA, Gilberto Vaz; CICCO, Rafael De; KOWALSKI, Luiz Paulo; MATOS, Leandro Luongo deObjective: The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers.Methods: An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April -June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020.Results: The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n = 19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly.Conclusions: The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. Level of evidence: Evidence from a single descriptive study. (c) 2023 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Tumor volume as a prognostic factor of locally advanced laryngeal cancer(2021) ANDRADE, Natalia Martins Magacho de; DEDIVITIS, Rogerio Aparecido; RAMOS, Daniel Marin; MATOS, Leandro Luongo; GARCIA, Marcio Ricardo Taveira; CONTI, Gustavo Goncalves; KOWALSKI, Luiz PauloPurpose The TNM tumor staging system is the most widely used for laryngeal cancer. However, in the same T stage, lesions with different primary tumor volumes (TV) can be found, impacting treatment outcomes. Methods 145 patients with T3 and T4a laryngeal cancer, according to Union for International Cancer Control, who underwent surgical treatment from 2008 to 2017, were analyzed. TV measurements were collected and compared to different outcomes. Results The mean TV was 23.0 +/- 16.4 cm(3). A cutoff point for TV of 14.2 cm(3) was established. Cumulative sample 5-year overall survival (OS) was 62.1%, while 5-years disease-free survival (DFS) was 65.5%. In univariate analysis, TV >= 14.2 cm(3) was associated with a higher risk of distant metastases (p = 0.045), and worse rates of OS (p = 0.009) and DFS (p = 0.035). In multivariate analysis, TV was not an independent risk factor of worse DFS (p = 0.569) or OS (p = 0.094). Conclusion Primary lesion TV showed significant association, in univariate analysis, with worse rates of recurrence and survival in advanced laryngeal cancer undergoing surgical treatment and can be a promising prognostic for these patients.
- Cancer-associated fibroblast regulation by microRNAs promotes invasion of oral squamous cell carcinoma(2020) MATOS, Leandro Luongo; MENDERICO JUNIOR, Gilberto Mendes; THEODORO, Therese Rachell; PASINI, Fatima Solange; ISHIKAWA, Marina de Menezes; RIBEIRO, Andromeda Aryane Bomtempo; MELLO, Evandro Sobroza de; PINHAL, Maria Aparecida da Silva; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio Aparecido; CERNEA, Claudio Roberto; KOWALSKI, Luiz PauloThe objective of the present study was to evaluate the role of microRNA-mediated remodeling of the extracellular matrix in the process of tumor invasion of oral squamous cell carcinoma and to evaluate its relationship with the prognosis of these patients. This was a retrospective study on material from the paraffin blocks of patients operated on for oral squamous cell carcinoma, in addition to a group of healthy oral mucosa samples of paired patients. miR-1-3p, miR-133-3p, and miR-21-5p were differentially expressed between the superficial and deep tumor groups. miR-21-5p was the one with the greatest accuracy in the differentiation between superficial and deep tumors. By immunohistochemistry, the group of deep tumors showed greater immunoreactivity to matrix metalloproteinases 2 and 9 and laminin a in tumor-associated fibroblasts, with consequent degradation of the basal membrane, measured by greater loss of continuity of type IV collagen. This process was also associated with lower and higher expression of miR-1-3p and miR-21-5p, respectively. There was also a trend toward better overall and disease-free survival rates in patients with higher miR-133a-3p. The present study showed the interaction between microRNAs and extracellular matrix remodeling in oral squamous cell carcinoma.