Surfing prognostic factors in head and neck cancer at the Millennium

doi:10.1016/S1368-8375(99)00043-3

Oral Oncology

Volume 35, Issue 6, November 1999, Pages 590-596

https://doi.org/10.1016/S1368-8375(99)00043-3 Get rights and content

Abstract

The ability to reliably predict cancer outcome could tailor therapy to the aggressiveness of the tumour to achieve the best results in terms of loco-regional control, overall survival and quality of life. Retrospective and prospective clinical trials involving large series of patients have validated some predictive clinical and pathological factors, whereas the utility of many other prognostic factors has not been established. This has led to some confusion in clinical practice. In order to clarify the significance, role and cost of these prognostic factors we carried out a Medline search of all papers published between 1993 and 1998 concerning the reliability and cost of markers with prognostic significance, in head and neck squamous cell carcinoma, and assessed the results according to a number of criteria relating to reliability and cost. Regarding reliability we classified prognostic factors into: (1) those with a proven significance based on the fact that they were unanimously reported as having an independent statistical correlation with outcome and prognosis; and (2) those for which results were not unanimous, and which significance is still controversial. Cost analysis showed a substantial difference between validated tests which are of low cost and experimental tests which are expensive. Based on these data regarding both the reliability and cost of each prognostic factor, we propose guidelines for their use in clinical practice in the year 2000.

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.

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Surfing prognostic factors in head and neck cancer at the Millennium

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgments

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