CELL-PROLIFERATION AS AN INDEPENDENT PREDICTOR OF SURVIVAL FOR PATIENTS WITH ADVANCED NASOPHARYNGEAL CARCINOMA

Commonly used clinical and pathologic criteria are often of limited va lue in predicting the outcome of patients with undifferentiated nasoph aryngeal carcinoma, and new parameters related to the biology of growt h of neoplastic cells are still required for better definition of the aggressiveness of these tumors. The prognostic significance of DNA plo idy, measured by image cytometry on isolated cells, and of the mitotic index, proliferating cell nuclear antigen, and p53 protein, all measu red by image cytometry in histologic sections, were evaluated on archi val tumor tissues from 53 patients with Stage III or IV nasopharyngeal carcinomas. Patients were staged according to the criteria of the Int ernational Union Against Cancer and were irradiated according to a con ventional radiotherapy schedule, No significant associations were foun d between biologic parameters and clinical features. Only the stage an d the mitotic index were related to patient survival, and, when examin ed in a proportional hazard regression analysis, both provided indepen dent information. When patients with compromised skull and/or cranial nerves (T4 tumors), who had a very short survival, were eliminated fro m the analysis, only the mitotic index and proliferating cell nuclear antigen allowed discrimination of a subset of patients with poor progn oses. This study shows that the assessment of cell proliferative activ ity can provide useful information for better predicting the clinical course of high-risk patients with nasopharyngeal carcinomas and improv e therapeutic strategies.