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Bhavna Kumar, MSc; Kitrina G. Cordell, DDS; Nisha D’Silva, BDS, MSD, PhD; Mark E. Prince, MD; Meredith E. Adams, MD; Susan G. Fisher, PhD; Gregory T. Wolf, MD; Thomas E. Carey, PhD; Carol R. Bradford, MD

Arch Otolaryngol Head Neck Surg. 2008;134(4):363-369.

Objective  To assess tumor markers in advanced laryngeal cancer.

Design  Marker expression and clinical outcome.

Patients  Pretreatment tumor biopsy specimens were analyzed from patients enrolled in the Department of Veterans Affairs Laryngeal Cancer Study.

Main Outcome Measures  Expression of p53 (OMIM TP53) and Bcl-xL (OMIM 600039) in pretreatment biopsy specimens was assessed for correlation with chemotherapy response, laryngeal preservation, and survival.

Results  Higher rates of larynx preservation were observed in patients whose tumors expressed p53 vs those that did not (80% [36 of 45 patients] vs 59% [24 of 41 patients], P =.03). Higher rates of larynx preservation were also observed in patients whose tumors expressed low levels of Bcl-xL vs high levels of Bcl-xL (90% [18 of 20 patients] vs 60% [30 of 50 patients], P =.02). Patients were categorized into 3 risk groups (low, intermediate, and high) based on their tumor p53 and Bcl-xL expression status. Patients whose tumors had the high-risk biomarker profile (low p53 expression and high Bcl-xL expression) were less likely to preserve their larynx than patients whose tumors had the intermediate-risk biomarker profile (high p53 expression and low or high Bcl-xL expression) or the low-risk biomarker profile (low p53 expression and low Bcl-xL expression). The larynx preservation rates were 100% (10 of 10 patients), 77% (26 of 34 patients), and 54% (7 of 13 patients) for the low-risk, intermediate-risk, and high-risk groups, respectively (P =.04, Fisher exact test).

Conclusion  Tumor expression of p53 and Bcl-xL is a strong predictor of successful larynx preservation in patients treated with induction chemotherapy and followed by radiation therapy in responding tumors.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Ms Kumar and Drs Prince, Adams, Wolf, Carey, and Bradford) and Pathology (Drs Cordell and D’Silva), Medical School, and Department of Periodontics and Oral Medicine, School of Dentistry (Drs Cordell and D’Silva), University of Michigan, Ann Arbor; and Department of Community and Preventive Medicine, University of Rochester, Rochester, New York (Dr Fisher).

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