INTRATUMORAL MICROVESSEL DENSITY AND P53 PROTEIN - CORRELATION WITH METASTASIS IN HEAD-AND-NECK SQUAMOUS-CELL CARCINOMA

Squamous-cell carcinoma of the head and neck includes a heterogeneous group of tumours of the upper air and food passages for which prognosi s is difficult to assess. In fact, patients in comparable stages may h ave diverse clinical courses and responses to similar treatments. In o rder to better define the prognosis of each patient there is therefore a need to identify novel biological markers which reflect more accura tely growth rate, progression and metastatic potential of each tumour. We assessed whether metastases correlate with microvessel counts (i.e . intratumoral vascularity) using the CD-31 monoclonal antibody (MAb) and p53 mutant protein expression, determined in the primary by immuno cytochemical methods in 70 patients with locally advanced head and nec k cancer. Patients were treated with concurrent chemo-radiotherapy; 50 of these presented loco-regional node metastasis at diagnosis whereas 3 cases, initially node-negative, developed distant metastasis during the period of observation. No feature was predictive for objective re sponse to treatment. The overall mean and median blood vessel density at ''hot spots'' was 37.42 and 36, respectively, and 57% of the tumour s expressed p53 mutant proteins. These 2 biological markers were signi ficantly associated. Patients with metastases (loco-regional and dista nt) had a significantly higher mean blood-vessel density than those wi thout tumour spread. Also, patients with p53-positive (+/++) tumours h ad a significantly higher incidence of metastasis than those with nega tive ones. Multivariate analysis showed that both vascularity and stag e, but not p53 expression, are significant and independent predictors of metastasis in this series. (C) 1993 Wiley-Liss, Inc.