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Prognosis in Head and Neck Cancer

Poornima U. Hegde, MD; Amy C. Brenski, MD; David D. Caldarelli, MD; James Hutchinson, MD; William R. Panje, MD; Nancy B. Wood, PhD; Sue Leurgans, PhD; Harvey D. Preisler, MD; Samuel G. Taylor IV, MD; Leslie Caldarelli; John S. Coon, MD, PhD

Arch Otolaryngol Head Neck Surg. 1998;124:80-85.

Objectives  To assess how p53 gene mutations and microvessel density (MVD) may be used as prognostic markers for the study and management of head and neck squamous cell carcinomas and to investigate putative associations between p53 gene mutations and MVD and the relationship of these factors to tumor response to radiotherapy and/or chemotherapy at 6 weeks.

Patients and Design  Thirty-nine patients with squamous cell carcinoma of the head and neck, stages I to IV, who were examined at Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill, and its affiliated hospitals between 1993 and 1995 were monitored. Mutations in the p53 gene were identified by microdissection of tumor cells on frozen sections, followed by single-strand conformation polymorphism analysis of the products of polymerase chain reaction amplification of exons 5 to 9. The microvessels were immunostained with monoclonal antibodies to factor VIII and/or CD31. Microvessel counts were done by 2 investigators blinded to each other's counts and to the p53 gene status. Intratumoral or peritumoral microvascular "hot spots" were assessed and counts were done with an ocular grid in 3x200 fields of hot spots by each investigator. The mean of the highest values was considered. Statistical analysis was done with the Wilcoxon rank sum test, the log-rank test, and proportional hazard models.

Results  Of the 39 patients, 13 had mutations in exons 5 to 9. Mutations in the p53 gene were associated with unfavorable overall (P=.003) and disease-free (P=.02) survival. A strong inverse relationship was seen between MVD and p53 mutations (P=.01). No statistically significant relationship was seen between mean MVD and overall and disease-free survival. The response to therapy differed significantly (P=.03) by p53 mutations, whereas there was no statistical significance with MVD counts.

Conclusion  In this study a strong inverse relationship was seen between MVD and p53 mutations. p53 Mutations in exons 5 through 9 were associated with unfavorable survival, whereas MVD showed no association with survival.

From the Departments of Pathology (Drs Hegde, Wood, and Coon and Ms Caldarelli), Otolaryngology–Head and Neck Surgery (Drs Brenski, Caldarelli, Hutchinson, Panje, and Coon), and Preventive Medicine (Dr Leurgans) and Rush Cancer Institute (Drs Preisler and Taylor), Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.

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