PROGNOSTIC-SIGNIFICANCE OF CELL-KINETICS IN LARYNGEAL SQUAMOUS-CELL CARCINOMA - CLINICOPATHOLOGICAL ASSOCIATIONS

A consecutive series of 99 untreated patients undergoing radical surgi cal resection for stage I-IV laryngeal carcinomas has been studied pro spectively. Our purpose was to analyze the predictive relevance of pro liferative variables studied [proliferating cell nuclear antigen (PCNA ) expression, volume-corrected mitotic (M/V) index, and S-phase fracti on (SPF)] on clinical outcome in relation to DNA ploidy and clinicopat hological features. All of the patients were followed up for a median of 32 months (range, 5-58 months). A weak, but significant, positive c orrelation was found between M/V and PCNA indices (except the PCNA wei ghted mean index:labeling index ratio) or these indices and SPF. At un ivariate analysis, node positivity (P < 0.05), poor histological grade (P < 0.01), DNA aneuploidy (P < 0.01), a high SPF (P < 0.01), and a h igh MN index (P < 0.05) proved to be related significantly to quicker relapse, whereas T-4 (P < 0.05), subglottic site (P < 0.05), DNA aneup loidy (P < 0.01) and a high SPF (P < 0.01) were related significantly to shorter overall survival. With multivariate analysis, a high SPF (> 12.1%) and histological grade (G(3)) were related to the risk of relap se (relative risk, 8.65 and 5.45, respectively), whereas only a high S PF was related independently to the risk of death (relative risk, 7.30 ). Our study has identified SPF, in addition to histological grade, as an important biological indicator in laryngeal carcinomas.