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Michael F. Spafford, MD; John Koeppe; Zhaoxing Pan, MB, MS; Philip G. Archer, ScD; Arlen D. Meyers, MD, MBA; Wilbur A. Franklin, MD

Arch Otolaryngol Head Neck Surg. 1996;122(6):627-632.

Abstract
Background
Recent basic discoveries about the biological significance of nuclear and cell-surface marker proteins have opened new areas of research into head and neck cancer. However, the clinical significance of these markers is not yet understood.

Objective
To perform a historical prospective study of 70 patients with squamous cell carcinoma of the larynx who were treated at our institution between 1979 and 1989 to correlate tumor marker expression with survival and metastasis.

Design
Archival tissue was immunohistochemically stained for the p53 tumor suppressor gene product, the inhibitor of apoptosis (bcl-2), the stem cell marker CD34, the cell adhesion molecules CD44H and CD44v6, and a marker of cellular proliferation (Ki-67). The slides were examined using a light microscope and scored according to intensity and percentage of cells labeled. The patients were stratified by tumor stage, and survival and metastatic data were correlated with staining scores.

Results
For the stage IV group, increased expression of p53 and decreased expression of CD44H and CD44v6 correlated with a decreased survival (P=.03, P=.03, and P=.02, respectively), and decreased expression of CD44H correlated with an increase in metastasis (P=.01). For all stages, excluding metastatic cases, increased p53 expression was consistent with a shorter survival (P<.03), while increased CD44v6 expression was consistent with a longer survival (P<.02).

Conclusions
The present study suggests that a loss of cell proliferation control implied by overexpression of p53 and loss of cell adhesion implied by decreased expression of CD44 may be determinants of survival in patients with carcinoma of the larynx. The tumor markers bcl-2 and Ki-67 were not prognostic discriminators in this limited series. This study also indicates that the stem cell marker CD34 is rarely expressed by laryngeal carcinoma cells.

(Arch Otolaryngol Head Neck Surg. 1996;122:627-632)

Author Affiliations
From the Department of Periodontics, College of Dentistry (Drs Rubright and Kohout) and the Departments of Otolaryngology (Drs Hoffman, Graham, Funk, and McCulloch), Pathology (Dr Robinson), and Preventive Medicine and Environmental Health (Dr Lynch), College of Medicine, University of Iowa, Iowa City.; From the Departments of Otolaryngology—Head and Neck Surgery (Drs Spafford and Meyers), Biometrics and Preventative Medicine (Drs Pan and Archer), and Pathology (Dr Franklin), and School of Medicine (Mr Koeppe), University of Colorado Health Sciences Center, Denver, and the Denver Veterans Administration Medical Center (Drs Meyers and Franklin).

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