Objective
The survival rate for head and neck squamous cell carcinoma (HNSCC) is among the lowest of the major cancers and has not substantially improved in the past two decades. Tumours with similar ...histological features may have widely differing clinical outcomes and thus identification of prognostic and predictive biomarkers may be valuable for determining appropriate clinical management strategies. The objective of this study was to establish the prognostic significance of six molecular markers in HNSCC in a New Zealand population: matrix metalloproteinases 2 and 9 (MMP‐2, MMP‐9), tissue inhibitor of matrix metalloproteinase‐1, sialyl Lewis antigens a and x (sLea, sLex) and alpha B‐crystallin.
Methods
Retrospective review of 145 sequential HNSCC patients from a tertiary centre with minimum 3 years surveillance. Sections from formalin‐fixed paraffin‐embedded tumour blocks were immunostained for the molecular markers and scored. Cox regression modelling was used to adjust for potential confounding variables impacting on cancer survival.
Results
Multivariate analysis for individual biomarkers, controlling for age, sex, tumour grade, N‐stage, T‐stage, tumour site, smoking history and alcohol use, revealed poorer survival with tumour expression of MMP‐2 (hazard ratio = 1.98, 95% confidence interval: 1.11–3.52, P = 0.021) and sLex (hazard ratio = 3.22, 95% confidence interval: 1.33–7.80, P = 0.010). A stepwise analysis showed that MMP‐2 and sLex were independently prognostic after covariate adjustment.
Conclusions
MMP‐2 and sLex were negative prognostic markers for survival in these HNSCC patients. This offers opportunities for clinical trials to reduce the risk of nodal and distant metastases through blocking tumour cell adhesion to endothelium.
Abstract
Objective
The survival rate for head and neck squamous cell carcinoma (
HNSCC
) is among the lowest of the major cancers and has not substantially improved in the past two decades. Tumours ...with similar histological features may have widely differing clinical outcomes and thus identification of prognostic and predictive biomarkers may be valuable for determining appropriate clinical management strategies. The objective of this study was to establish the prognostic significance of six molecular markers in
HNSCC
in a
N
ew
Z
ealand population: matrix metalloproteinases 2 and 9 (
MMP
‐2,
MMP
‐9), tissue inhibitor of matrix metalloproteinase‐1, sialyl
L
ewis antigens a and x (
sLe
a
,
sLe
x
) and alpha
B
‐crystallin.
Methods
Retrospective review of 145 sequential
HNSCC
patients from a tertiary centre with minimum 3 years surveillance. Sections from formalin‐fixed paraffin‐embedded tumour blocks were immunostained for the molecular markers and scored.
C
ox regression modelling was used to adjust for potential confounding variables impacting on cancer survival.
Results
Multivariate analysis for individual biomarkers, controlling for age, sex, tumour grade,
N
‐stage,
T
‐stage, tumour site, smoking history and alcohol use, revealed poorer survival with tumour expression of
MMP
‐2 (hazard ratio = 1.98, 95% confidence interval: 1.11–3.52,
P
= 0.021) and
sLe
x
(hazard ratio = 3.22, 95% confidence interval: 1.33–7.80,
P
= 0.010). A stepwise analysis showed that
MMP
‐2 and
sLe
x
were independently prognostic after covariate adjustment.
Conclusions
MMP
‐2 and
sLe
x
were negative prognostic markers for survival in these
HNSCC
patients. This offers opportunities for clinical trials to reduce the risk of nodal and distant metastases through blocking tumour cell adhesion to endothelium.
A study was undertaken to determine whether the Provox voice prosthesis provides good voice rehabilitation following a total laryngectomy in the urban, suburban and rural populations served by a ...tertiary referral hospital in South Africa. Between 1995 and 1999, a cohort of 128 patients at Tygerberg Hospital was rehabilitated with the Provox voice prosthesis after laryngectomy. In 104 patients primary placement of the prosthesis was done at the time of the laryngectomy. Mean device life and adverse events were determined. Voice quality was assessed subjectively in 104 patients and objectively in 26 patients. The mean device life was 303 days and adverse events occurred in 16 patients. Subjectively, 77 of 104 patients had a good voice, and objectively 22 of 26 patients had good voice intelligibility. The Provox voice prosthesis provides good voice rehabilitation following total laryngectomy, with minimal complications, in the population served by Tygerberg Hospital.
To assess the value of ultrasonography (US) combined with fine-needle aspiration (FNA) cytology for the investigation of lymph node metastases in patients with head and neck cancer.
Comparison of ...clinical examination (palpation) and preoperative US-FNA examination results of cervical nodes in a sample of patients with head and neck cancer. The histological features of the neck dissection specimens are used to validate these 2 variables.
A head and neck oncology service in a tertiary referral hospital.
A consecutive sample of 56 patients with head and neck squamous cell carcinoma, first seen between April 1, 1996, and July 30, 1998, who had neck dissections performed after the US-FNA examination.
Cervical US-FNA preoperatively, followed by elective or therapeutic radical modified or selective neck dissection.
The histological examination results of subsequent neck dissection specimens are used to determine the sensitivity, specificity, and accuracy of US-FNA for individual nodes. Second, the results of node staging by clinical examination and US-FNA examination are compared.
The sensitivity was 89.2%; specificity, 98.1%; and accuracy, 94.5%. Correct node stages were obtained in 52 (93%) of the patients using US-FNA compared with 34 (61%) using palpation.
Ultrasonography combined with FNA is a highly accurate technique for the investigation of cervical lymph node metastases. A more accurate diagnosis may result in more appropriate treatment, particularly in a setting with limited resources. Retropharyngeal nodes, micrometastases, and lymph nodes smaller than 4 mm are limitations of US-FNA. Ultrasonography combined with FNA is a useful technique for the staging of head and neck cancer.
A retrospective review of patients from 1979 to 1988 was performed to assess the efficacy of neck dissection, prognostic factors, and the philosophy of treatment of the neck in supraglottic cancer. ...Of the 89 patients available for analysis, 26 were managed by horizontal partial laryngectomy (HPL), 44 by primary radiotherapy (RT), and 19 by total laryngectomy (TL). A total of 41 patients from the group had 63 neck dissections (NDs); 22 had bilateral and 19 unilateral dissections. A correlation of the pN with N staging revealed that when presenting with N2a nodes (> 3 cm), one third had contralateral metastases, and with N2b (multiple), 100% had contralateral metastases. In multivariate analysis of the disease-free interval, age and staging emerged as independent prognostic variables. Although we observed no increased morbidity by dissecting the opposite side, our results did not support routine bilateral neck dissection in NO patients. However, when the nodes are larger than 3 cm, or ipsilateral and multiple, bilateral neck dissection is recommended.
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