Slajd 1

1
The molecular and pathological predictors of
loco-regional tumor control and distant
metastases in a randomized clinical trial on
7-days-a-week postoperative radiotherapy for
squamous-cell head and neck cancer
Rafal Suwinski1, Magdalena Jaworska1, Barbara
Nikiel1, Monika Bialas1, Magdalena
Bankowska-Wozniak2, Anna Mucha-Malecka3,
Wojciech Majewski1, Krzysztof Skladowski1, Adam
Maciejewski1, Dariusz Lange1
1 Comprehensive Cancer Centre, Gliwice, Poland. 2
Regional Center of Oncology, Bydgoszcz, Poland 3
Comprehensive Cancer Centre, Krakow, Poland
2
Purpose To identify the molecular and
pathological predictors of tumor control and
distant metastases based on the data from a
randomized clinical trial on 7-days-a-week
postoperative radiotherapy for squamous-cell
head and neck cancer
3
Material and methods Between 2001 and 2004 279
patients with high-risk squamous cell cancer of
the head and neck were enrolled to the trial and
randomized to receive 63 Gy in fractions of 1.8
Gy given 5- or 7-days-a-week. The clinical
outcome of a trial has been presented elsewhere
(Radiother Oncol 2007,82,Suppl 137). For this
report we used 125 pathological samples from the
trial that were available for immunohistochemical
assays.
4
Results
Table 1. Impact of the molecular and pathological
tumor features on loco-regional tumor control
and distant metastases in a randomized trial on
7-days-a-week postoperative radiotherapy.
Results of Cox proportional hazard regression
analysis.
Pathological/molecular feature Loco-regional control (p-value) Distant metastases (p-value)
EGFR expression 0.008 0.28 (NS)
nm23 expression 0.01 0.33 (NS)
p53 expression 0.69 (NS) 0.86 (NS)
Ki67 expression 0.53 (NS) 0.27 (NS)
cyclin D 0.87 (NS) 0.69 (NS)
number of invaded neck nodes 0.0001 0.0002
extracapsular extension 0.009 0.0003
invasion of the resection margin 0.22 (NS) 0.93 (NS)
tumor grade 0.78 (NS) 0.34 (NS)
presence of necrosis 0.83 (NS) 0.007
presence of keratosis 0.19 (NS) 0.004
Remained significant in a multivariate analysis
NS not significant
5
Figure 1 Locoregional control according to the
expression of , nm23, and the number of
involved neck nodes
Figure 2 Locoregional control (left) and distant
metastases (right) according to the joint risk
score developed based on the significant
risk-factors shown in Table 1.
6
Conclusions These results support the studies
which indicate that high expression of EGFR and
nm23 appears to be a strong negative predictor
of loco-regional tumor control in squamous cell
cancer of the head and neck. The conventional
pathological markers (necrosis, keratosis,
invaded nodes) appeared to be the best
predictors of distant metastases. Combining
individual risk factors in a joint risk score
may improve the predictive potential.