Rudolf Fries

The prognostic relevance of various factors at the time of the first admission of the patient: Retrospective DÖSAK study on carcinoma of the oral cavity

In a retrospective study, on a sample of 1021 patients with carcinoma of the lips, oral cavity and oropharynx, the clinically available factors at the time of the patients first admission are analysed with reference to their prognostic relevance. Prognostically relevant factors are determined by both univariate and multivariate analyses. Of the 18 factors analysed, the following seven finally proved to be prognostically relevant: tumour size, degree of infiltration, degree of histological differentiation and site by organ of the primary tumour, the combination of evidence + clinical appearance + degree of fixation of the regional lymph nodes, age of the patient, and evidence of distant metastases. On the basis of these results it will be possible to create a prognostic index. This prognostic index should be eligible for use in clinical practice, as opposed to usual classification models.

Advantages of a basic concept in lip reconstruction after tumour resection.

Summary This paper presents a “Universal Procedure” for the reconstruction of defects of lips following tumour resection. This method which has been developed from the Bernard Repair can, contrary to other methods, be judiciously adapted in nearly all lip defects. The frequent use of a single, methodical principle rewards the surgeon with more abundant personal experience. This, in turn, yields better results in the repair of form and function of lips.

Retrospective DÖSAK study on carcinomas of the oral cavity: Results and consequences***

In a multicentre, retrospective observational study on carcinomas of the oral cavity, including the lips and oropharynx, data material of 1021 patients has been analysed. The specific goals of this study were: Review of existing proposals for classification. Analysis of prognostically relevant factors of the tumour disease. Construction of a prognostic index for the determination of individual and collective prognoses. The following results were achieved: ad 1: All existing TNM-Classifications of oral cavity carcinomas so far fail to meet the requirements of the necessary criteria. ad 2: The multivariate analyses of prognostically relevant factors were performed with and without taking therapeutic factors into account. The results show unequivocally that reliable prognoses are only possible if various treatment modalities are considered. ad 3: This led to the construction of the treatment-dependent prognostic index TPI, which will be eligible for use in clinical-therapeutic cancer research and in clinical practice.

Retrospektive DÖSAK-Studie über Karzinome der Mundhöhle

Lymfaticke uzliny mohou být postiženy mnoha patologickými procesy, ktere zahrnuji zanětlive změny specificke a nespecificke etiologie, řadu benignich reaktivnich změn a postiženi primarnimi a sekundarnimi nadory. Zobrazeni a nasledne vyhodnoceni lymfatických uzlin jako benigni nebo potencialně maligni je důležite zejmena v ramci stagingu nadorových onemocněni a u pacientů s nahodně zjistěnou lymfadenopatii. Prace předklada přehled zobrazovacich metod použivaných v diagnostice lymfadenopatii. V textu je uvedena i moderni metoda kontrastni ultrasonografie hodnotici perfuzni změny uzliny po intravenozni aplikaci mikrobublinove kontrastni latky, doplněna o obrazovou dokumentaci nasich pacientů. Uvedeny jsou i dalsi metody – výpocetni tomografie a magneticka rezonance vcetně jejich limitaci a dnes již výjimecně použivana přima rentgenova lymfografie.In einer multizentrischen, retrospektiven Beobachtungsstudie uber Karzinome der Mundhohle einschlieslich Lippen und Oropharynx wurden anhand eines Datenmaterials von 1021 Patienten 3 wesent-liche Ziele verfolgt: Uberprufung vorhandener Klassifizierungsvorschlage; Analyse prognostisch relevanter Faktoren der Tumorkrankheit; Erstellung eines Prognoseindex zur individuellen und kollektiven Prognosestellung. Die Untersuchungen erbrachten folgende Ergebnisse: ad 1: Die TNM-Klassifizierungen fur Mundhohlenkarzinome weisen schwere Mangel auf und sind deshalb nicht zielfuhrend. ad 2: Die ohne und mit Berucksichtigung der Therapie erfolgten mehrdimensionalen Analysen prognostisch relevanter Faktoren zeigen eindeutig, das eine verlasliche Prognosestellung nur unter verschiedenen therapeutischen Voraussetzungen erfolgen kann. ad 3: Letzteres fuhrte zur Erstellung des therapieabhangigen Prognoseindex TPI, der den Anforderungen der klinisch-therapeu-tischen Krebsforschung und der klinischen Praxis gerecht wird.

TNM-classification of carcinomas of the oral cavity — efficacy of clinically available data (TN)

Using adequate number of cases, the influence of the spread of primary tumour and the degree of regional metastasis on prognosis were investigated. Assuming a practicable classification as a prerequisite for clinico-therapeutic cancer research, experience has shown that the assessment of the spread of primary tumour alone does not suffice for the establishment of comparable homogenous data. The investigation on the importance of the degree of regional metastasis has shown, above all, that the percentage of N3-metastasis within the T-groups contributes essentially to the fact that these show a marked difference in their prognosis. It would therefore appear necessary also to examine the importance of other clinically accessible data in the assessment of prognosis. Only then could we be in a position to judge whether, and to what extent a clinically practicable classification and integration into special groups is possible on the basis of clinically available data. The inclusion of more clinics in the joint investigation is encouraged.

Carcinoma of the oral cavity: on the prognostic significance of the primary tumour site (by levels and areas).

The prognostic significance of primary tumour site in carcinomas of the oral cavity was investigated in a series of 585 cases. For the subsamples (levels and areas of oral cavity) studied, the numerical distribution of TNM categories, life tables and life table comparisons were computed. This produced the following results: Given an identical extension and analogous metastazising rate, there is no computationally demonstrable difference in prognosis between primary tumours sited at different levels and areas of the oral cavity. The exception are the T1Nx categories, for which a difference exists between precanine and retromolar sites. These results should be re-examined on the basis of a larger series.

Surgical correction of cartilaginous nasal septum deformities.

Septal cartilage deviations which are usually present in deformities of the cartilaginous nasal septum are corrected by scarification on the concave side of the curvature. Histological studies indicated that this procedure was best adapted to the structure of the elastic fibres constituting the cartilaginous nasal septum. Follow-up examinations in 33 patients who having undergone surgery showed nasal breathing to be unobstructed bilaterally in all cases; in 29 patients an aesthetically satisfactory nasal shape was restored and full re-alignment of the cartilaginous nasal septum was obtained.