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Ivan Marcelo Gonçalves Agra, MD; André Lopes Carvalho, MD, PhD; Clovis Antônio Lopes Pinto, MD, PhD; Everton Pontes Martins, MD; João Gonçalves Filho, MD, PhD; Fernando Augusto Soares, MD, PhD; Luiz Paulo Kowalski, MD, PhD

Arch Otolaryngol Head Neck Surg. 2008;134(7):743-749.

Objective  To analyze the prognostic effect of epidermal growth factor receptor (EGFR), matrix metalloproteinases 2 and 9, and vascular endothelial growth factor expression in patients with locally recurrent oral carcinoma after salvage surgery.

Design  Retrospective cohort study.

Settings  Tertiary center cancer hospital.

Patients  The charts of 111 patients with local recurrence of oral carcinomas were retrospectively analyzed. The previous treatment consisted of surgery in 33 patients (30.0%), radiotherapy with or without chemotherapy in 46 patients (41.0%), and surgery with adjuvant radiotherapy in 32 patients (29.0%). The expression of EGFR, matrix metalloproteinases 2 and 9, and vascular endothelial growth factor was analyzed with a tissue microarray immunohistochemical technique.

Main Outcome Measures  Overall survival and cancer-specific survival (CSS).

Results  The recurrences were diagnosed in less than 1 year in 69 patients (62.2%) and in more than 1 year in 42 patients (37.8%). The prognosis was worse in the group with the disease-free interval of less than 1 year (P = .01). Patients with more advanced disease (clinical stage of recurrence, III/IV) had worse rates of CSS (P = .04). Cases that were positive for EGFR had a 3-year CSS of 27.2%, while EGFR-negative cases had a 3-year CSS of 64.3% (P = .001). The expression of matrix metalloproteinases 2 (P = .83) and 9 (P = .15) and vascular endothelial growth factor (P = .86) was not significant in this group. In multivariate analysis, only the disease-free interval and the overexpression of EGFR were associated with a higher risk of cancer death.

Conclusions  Local recurrence in oral carcinomas carries a poor prognosis. A disease-free interval of more than 1 year and a EGFR-negative expression are the main prognostic factors related to better CSS in patients treated with salvage surgery.

Author Affiliations: Departments of Head and Neck Surgery–Otorhinolaryngology (Drs Agra, Carvalho, Martins, Filho, and Kowalski) and Pathology (Drs Pinto and Soares), Hospital A. C. Camargo, and Department of Oncology, University of São Paulo (Dr Martins), São Paulo, Brazil.

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