Kota Kida

Relationship Between p16 Expression and Prognosis in Patients with Oropharyngeal Cancer Undergoing Surgery

Background/Aim: Prognostic impact of p16 expression in patients with oropharyngeal squamous cell carcinoma (OSCC) undergoing surgery is not fully examined. The aim of this study was to clarify these issues. Patients and Methods: Sixty-four OSCC subjects were analyzed. Immuno-histochemical staining of p16, a surrogate marker for human papillomavirus (HPV), was performed histopathologically. Data were retrospectively analyzed according to p16 positivity and factors linked to prognosis were also analyzed. Results: No significant difference was observed in the prognosis between the p16-positive group (n=28) and the p16-negative group (n=36). In patients undergoing post-operative radiation, the p16-positive group (n=18) had a significantly better prognosis than the p16-negative group (n=6). On multivariate analysis, transoral surgery was a significant predictor of overall survival (p=0.0173). Conclusion: Prognostic impact of p16 can be emphasized in a subgroup of OSCC patients undergoing surgery. Surgery with sufficient surgical margin may be chosen as the first treatment for HPV-negative OSCC in some cases.

Clinical Study of Surgical Resection for Pulmonary Metastasis of Head and Neck Cancer

Objectives: Although chemotherapy is a common treatment for pulmonary metastasis of head and neck cancer, the prognosis is still poor. This study aimed to examine and evaluate the efficacy of surgical resection for pulmonary metastasis of head and neck cancer. Methods: A total of 15 patients who had undergone 19 resections were examined at our hospital between 2005 and 2012. The patients were followed up for at least 22 months after the surgery, or until their death, with a median period of 36 months. Among the 15 patients, 11 had squamous cell carcinoma, 3 had adenoid cystic carcinoma, and one had malignant melanoma. Results: Of the 19 resections, partial lung resection was performed in 13 cases, lobectomy in 4, and segmentectomy in 2. Video-assisted thoracic surgery was performed in all cases. The mean surgical time, operative blood loss, and length of postoperative hospital stay were 104 minutes, 64 mL, and 7.8 days, respectively. Only 1 patient showed deterioration of the postoperative performance status. For patients with squamous cell carcinoma, the number of pulmonary metastases was 2 or less at the preoperative evaluation. The 3- and 5-year disease-specific survival rates after surgical resection in patients with squamous cell carcinoma were 54.6% and 20.5%, respectively. All patients with adenoid cystic carcinoma and malignant melanoma have survived to date. Conclusions: Lung surgical resection can be considered as one of the effective treatments for pulmonary metastasis of head and neck cancer to improve patient prognosis, with minimal invasion and complications.

Risk Factors for Cervical Lymph Node Metastasis of Tongue Carcinoma to the Unaffected Side

Objectives: Investigate the relationship between cervical lymph node metastasis of tongue carcinoma in unaffected and affected sides and factors related to the primary site. Methods: Between January 2000 and December 2009, 248 patients with primary N0 tongue carcinoma in the unaffected side were treated radically at the Department of Otolaryngology, Osaka Medical Center for Cancer and Cardiovascular Diseases. We evaluated clinical T stage, tumor size, tumor extension (oral floor, anterior part of the tongue, root of the tongue, depth into the tongue) and clinical N stage for risk factors influencing cervical lymph node metastasis to the unaffected side. Results: Fourteen of 248 patients (5.6%) showed cervical node metastasis in the unaffected side. The rate of metastasis to the unaffected side was 17% in patients with primary site extending to the anterior part of the back of the tongue (P < 0.01). The rate was 16% in patients with primary site extending to more than half of the tongue depth (P < 0.05). The rate was 14% in patients with cN+ in the affected side (P < 0.01). Other factors were not associated a significant difference. Conclusions: Extending to the anterior part of the back of the tongue, more than half of the tongue depth and cN+ in the affected side were high risk factors of cervical lymph node metastasis to the unaffected side.

CD44 Expression in Biopsy Specimens of Patients with Nasopharyngeal Carcinoma Is Associated with Prognosis

Objectives: CD44 is a major cancer stem cell marker, and it has been reported to be associated with biological malignancy in several cancers. However, the potential oncogenic role of CD44 and its clinical/prognostic significance in nasopharyngeal carcinoma (NPC) are unclear. In this study, we evaluated the association of CD44, especially its variant isoforms V3 and V6, with prognostic factors in NPC patients. We examined CD44 expression by immunohistochemical analysis of biopsy specimens obtained from 42 NPC patients who underwent treatment. Methods: The subjects were 42 patients (35 men and 7 women; average age, 56.3 years) who received concurrent chemoradiotherapy (CCRT) consisting of chemotherapy (CBDCA or CDGP or DOC) and radiation therapy (60-66 Gy) as an initial treatment. Thereafter, the biopsy specimens from these patients were examined immunohistochemically to study the association between CD44 expression (V3, V6) and prognosis of NPC. Results: High CD44 (V3, V6) expression was significantly correlated with increased clinical incomplete response to CCRT at the primary site (P = 0.008 in V3 and V6 by χ2-test) and poor disease-specific survival (P = 0.0003 in V3 and P = 0.0029 in V6 by log-rank test). However, distant metastasis showed no association with CD44 expression. Conclusions: High expression of CD44 (V3, V6) is associated with poor prognosis in patients with NPC. Evaluation of CD44, especially the variant isoforms V3 and V6, may be useful for predicting tumor response to CCRT and prognosis of patients with NPC.