Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): To evaluation of the efficacy of immunohistochemistry (IHC) panel in prediction prognosis of p-16 negative head and neck cancer (HNC).
Materials/Methods: This study reviewed cancer registry data of our hospital from 2010 to 2014 with following inclusion criteria: advanced HNC were diagnosed by pathologic examination, tissue available for staining of IHC panel (4 markers: p53, EGFR, cyclin D1, and ERCC1 proteins). Patients who had evident metastatic disease, ECOG performance score = 2 or more, or refuse curative treatment were excluded. IHC staining was performed by the same laboratory of department of pathology and was reviewed by same pathologist. All patients were treated by chemoradiation therapy. Patient characteristics, treatment parameter and clinical outcome were recorded. The primary end point was overall survival (OS), and the second endpoint was recurrence-free survival (RFS). Other events were also recorded, such as death cause, recurrence pattern, and second primary cancer.
Results: There were 75 eligible cases, with median follow-up period of 28 months of living patients. At the time of analysis, 20 patients had died, while 5 patients were alive with disease. The cause of death was cancer recurrence in 18 cases (24%), acute toxicities in 1 cases (1.3%), and second primary cancer in 3 cases (4%). The 3-year OS were 72.4%%. Univariate analysis revealed that anemia, clinical T4 disease, and clinical N2b/3 disease correlated with poor OS (p < 0.05). p53 staining > 70% of biopsy tissue correlated with poor OS with borderline significance (p = 0.059). Multivariate analysis showed that clinical T4 disease, clinical N2b/3 disease and p53 staining > 70% of biopsy tissue were independent poor prognostic factors (p < 0.05). The 3-year RFS were 54.9%. Univariate analysis revealed that anemia, clinical T4 disease, and clinical N2b/3 disease correlated with poor RFS (p < 0.05). Multivariate analysis showed that only clinical N2b/3 disease was independent poor prognostic factors (p < 0.05). Since p53 expression correlated with OS but not RFS, the correlation of p53 expression and other events were analyzed and a correlation between p53 staining > 70% of biopsy tissue and second primary cancer was found. Five of 19 patients with p53 staining > 70% of biopsy tissue developed second primary cancer while 4 of other 56 patients had second primary cancer (p = 0.041, Fisher’s exact test, 2-sided). And 2 patients with p53 staining > 70% of biopsy tissue died from second primary cancer but no patients died from second primary cancer in another group.
Conclusion: Although the IHC panel failed to predict the risk of cancer recurrence, the study found that p53 staining > 70% of biopsy tissue correlated with higher risk of developing second primary cancer. This result suggest that a more detailed cancer screening program should be applied to these patients. And the mechanism of this finding should be studied in further.
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