Surfing prognostic factors in head and neck cancer at the Millennium
Introduction
The ability to reliably predict cancer outcome is highly desirable. On the basis of such information, therapy could possibly be tailored to the aggressiveness of the tumour to achieve the best results in terms of loco-regional control, overall survival and quality of life. The considerable world-wide interest in this area of head and neck cancer is shown by the fact that, over the past 5 years, almost 2000 papers on prognostic factors have been published.
Retrospective and prospective clinical trials involving large series of patients have validated some of these factors whereas, unfortunately, the utility of many others has not been established. Furthermore, most of the new pathological, biological and molecular markers have not been sufficiently tested on adequate numbers of patients. This has led to confusion in clinical practice. Another aspect leading to confusion is the indiscriminate use of terms such as prognostic factor, risk factor, marker, etc., in the literature; some authors using these terms more or less synonymously, others with more specific meanings.
Furthermore, it has been the authors' experience from many centres that clinical records do not always record all the information derived from such investigation, even those which may be considered of established value.
Inappropriate use of these data in planning treatment, far from improving patient care may indeed at the very least increase costs and even worsen prognosis. Thus, there is a need to clarify the reliability and significance, role and costs of these prognostic factors: this is the aim we set ourselves in this study.
Section snippets
Methods
Our approach was extensive search of the literature for studies concerning markers with prognostic and predictive significance in head and neck squamous cell carcinoma (HNSCC) and to assess the results according to a series of criteria as previously described [1]. We thus performed a Medline search of papers published between 1993 and 1998, inclusively. We then included, for analysis only, papers with all the following four characteristics: (1) prognostic and predictive factors for HNSCC; (2)
Results
Among the possible tumour markers (Table 1) we considered only prognostic and predictive factors, because at present only they have clinical relevance [9]. In fact, risk and diagnostic factors are putative.
Discussion
Head and neck squamous cell carcinogenesis is considered a multi-step process involving multiple genetic alterations that initiate phenotypic changes [63]. A number of clinical, pathological and molecular factors have been identified, some of which provide information about aspects of the natural history and neoplastic evolution and could be indicators of the biological aggressiveness of the tumour [70], [71], [72], [73], [74], [75], [76], [77], [78], [79] (Table 1). The questions arise both as
Acknowledgments
The authors thank Don Ward for critically reading the manuscript.
References (85)
- et al.
The EORTC randomized trial on three fractions per day and misonidazole in advanced head and neck cancer: prognostic factors
Radiother Oncol
(1995) - et al.
Prognostic factors of survival in a cohort of head and neck cancer patients in Oslo
Eur J Cancer B Oral Oncol
(1996) - et al.
Nodal CT density and total tumor volume as prognostic factors after radiation therapy of stage III/IV head and neck cancer
Radiother Oncol
(1998) - et al.
Potential doubling time and clinical outcome in head and neck squamous cell carcinoma treated with 70 GY in 7 weeks
Int J Radiat Oncol Biol Phys
(1996) Prognosis in mouth cancer: tumour factors
Eur J Cancer B Oral Oncol
(1994)- et al.
Flow cytometric quantification of the proliferation-associated nuclear antigen p105 and DNA content in advanced head & neck cancers: results of RTOG 91-08
Int J Radiat Oncol Biol Phys
(1994) - et al.
Lack of predictive value of potential doubling time and iododeoxyuridine labelling index in radiotherapy of squamous cell carcinoma of the head and neck
Radiother Oncol
(1998) - et al.
Prognostic significance of cell proliferation markers and DNA-ploidy in head and neck tumors
Int J Radiat Oncol Biol Phys
(1998) - et al.
Lymph node prognostic factors in head and neck squamous cell carcinomas
Am J Surg
(1994) - et al.
DNA ploidy analysis of squamous cell carcinomas of the oral and maxillofacial region: clinical and pathologic correlations
Oral Surg Oral Med Oral Pathol Oral Radiol Endo
(1996)
Biological indicators of survival in patients treated by surgery for squamous cell carcinoma of the oral cavity and oropharynx
Oral Oncol
Tumor angiogenesis as a prognostic factor in oral cavity tumors
Am J Surg
Predictive assays of radiation response in patients with head and neck squamous cell carcinoma: a review of the Institute Gustave Roussy experience
Int J Radiat Oncol Biol Phys
Relevance of SCC-Ag, CEA, CA 19.9 and CA 125 for diagnosis and follow-up in oral cancer
J Craniomaxillofac Surg
Analysis of DNA ploidy using fresh frozen tissues of head and neck squamous cell carcinomas
Auris Nasus Larynx
The significance of PCNA and p53 protein in some oral tumors
Int J Oral Maxillofac Surg
Decreasing p53 overexpression in sequential, recurrent, oral squamous cell carcinomas
Br J Oral Maxillofac Surg
p53 overexpression in head and neck carcinoma and radiotherapy results
Int J Radiat Oncol Biol Phys
The erbB oncogenes as prognostic markers in oral squamous cell carcinomas
Am J Surg
Amplification of 11q13 DNA markers in head and neck squamous cell carcinomas: correlation with clinical outcome
Eur J Cancer
Familial risk in oral and pharyngeal cancer
Eur J Cancer B Oral Oncol
Prognostic significance of DNA ploidy in oral squamous cell carcinomas. A retrospective flow and image cytometric study with comparison of DNA ploidy in excisional biopsy specimens and resection specimens, primary, tumors, and lymph node metastases
Oral Surg Oral Med Oral Pathol Oral Radiol Endo
Prognostic value of tumor regression during radiotheraphy for head and neck cancer: a prospective study
Int J Radiot Oncol Biol Phys
Overexpression of p53 predicts organ preservation using induction chemotherapy and radiation in patients with advanced laryngeal cancer
Otolaryngol Head Neck Surg
Prognostic factors in head and neck oncology: a critical appraisal for use in clinical practice
Anticancer Res
The cost of cytokines
Rev. Prat.
Cost-effectiveness of tumor marker detection in cancer patients
Int J Biological Markers
Cost and value considerations in screening for oral cancer and precancer
Community Dent Health
A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps
Plast Reconstr Surg
Efficacy and cost-effectiveness of multihole fine-needle aspiration of head and neck masses
Laryngoscope
Soluble interleukin-2 receptor serum level as a predictor of locoregional control and survival for patients with head and neck carcinoma: results of a multivariate prospective study
Cancer
Do the conventional clinicopathologic parameters predict for response and survival in head and neck cancer patients undergoing neoadjuvant chemotherapy?
Tumori
Long-term survival data and prognostic factors of a complete response to chemotherapy in patients with head and neck cancer treated with platinum-based induction chemotherapy: a Hellenic Co-operative oncology Group study
Med Pediatr Oncol
Sedimentation rate and serum thymidine kinase activity: prognostic factors in squamous cell head and neck cancer
Head Neck
Levels of TGF-alpha and EGFR protein in head and neck squamous cell carcinoma and patient survival
J Natl Cancer Inst
Prognostic factors of cervical lymph node metastasis in head and neck squamous cell carcinoma
Tumori
Prognostic value of histologic findings in neck dissections for squamous cell carcinoma
Arch Otolaryngol Head Neck Surg
Analysis of prognostic factors for recurrence after neck dissection
Arch Otolaryngol Head Neck Surg
Prognostic value of clinicopathological parameters in head and neck squamous cell carcinoma: a prospective analysis
Br J Cancer
Cited by (43)
Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy
2019, European Journal of RadiologyCitation Excerpt :It is essential to identify tumor characteristics predictive of response to (chemo)radiotherapy to increase treatment efficacy and long-term outcome by treatment intensification or by offering alternative treatment options as early as possible to these patients (e.g. surgery or best supportive care). Besides clinical and histopathological factors [3], imaging parameters may provide important prognostic biomarkers [4,5]. Functional imaging, such as diffusion-weighted imaging (DWI) and 18F-Fluorodeoxyglucose positron-emission computer tomography (18F-FDG-PET/CT), could provide additional information on pathophysiology [6,7].
Detection of human papillomavirus (HPV) in clinical samples: Evolving methods and strategies for the accurate determination of HPV status of head and neck carcinomas
2014, Oral OncologyCitation Excerpt :Clinicians have not been able to rely on prognostic markers other than tumor stage in their care of patients with HNSCC. Numerous studies have addressed the prognostic relevance of cell proliferation (e.g. Ki67), p53 immunohistochemical staining, apoptosis, aneuploidy, Epidermal growth factor receptor overexpression and other markers of biologic activity, but none have proved consistently reliable across multiple studies [8–11]. Even histologic grade does not perform well as a prognosticator.
Loss of nuclear expression of Krüppel-like factor 4 is associated with poor prognosis in patients with oral cancer
2012, Human PathologyCitation Excerpt :Surgical resection combined with radiotherapy/chemotherapy is currently the primary treatment strategy, but the therapeutic effect remains unsatisfactory, and patients have a poor 5-year survival rate [2]. Some molecular markers of oral cancer have been proposed, but the unequivocal prognostic and/or predictive significance of the markers has not been established [3-8]. A prognostic marker that could act as a therapeutic target could potentially be used to develop new and effective treatment strategies for oral cancer.
2-[<sup>18</sup>F]-Fluoro-2-deoxy-d-glucose positron emission tomography as guidance for primary treatment in patients with advanced-stage resectable squamous cell carcinoma of the larynx and hypopharynx
2007, European Journal of Surgical OncologyCitation Excerpt :Because the success of treatment depends essentially on obtaining locoregional control, many predictors of response or survival after combined treatment have been identified. Outcome indicators in patients with head and neck cancer have traditionally been derived from clinical and pathologic features.3 Identification of additional prognostic factors for locoregional control and survival, particularly biologic parameters, may allow the development of individualized strategies that lead to improved local control and survival outcomes.