MARKERS FOR ASSESSMENT OF NODAL METASTASIS IN LARYNGEAL CARCINOMA

Background: Regional metastasis is an important factor in the treatmen t and prognosis of patients with head and neck squamous tell carcinoma . Although in recent years imaging techniques have improved, it is sti ll impossible to detect small metastatic deposits. Metastasis is mainl y determined by properties of the primary tumor and its interaction wi th surrounding structures. Objective: To identify markers that predict the presence of metastasis based on the features of the primary tumor . Design: Correlation of the results of histological, immunohistochemi cal, and molecular biological analysis with clinical and histopatholog ical data. Materials and Methods: Several histological features and bi ological markers were examined in 31 laryngeal carcinomas. The followi ng markers were selected on their putative role in the process of meta stasis and were studied using immunohistochemical and/or Southern blot techniques: proliferating cell nuclear antigen (PCNA), p53, retinobla stoma tumor-suppressor gene (Rb), myc, bcl-2 (inhibitor of apoptosis). epidermal growth factor (EGF), EGF-receptor (EGFR), neu, nm23 (also k nown as NME1, putative metastasis suppressor), desmoplakin, neuron cel l-adhesion molecule (N-CAM), epithelial cell-adhesion molecule (Ep-CAM ), E-cadherin, cyclin D1 (CCND1), and EMS1. Results: The presence of a n inflammatory reaction surrounding the tumor (P = .07), eosinophilic infiltration (P = .16), positive immunostaining for Rb (P = .02), nega tive immunostaining for Ep-CAM (P = .13), and amplification of CCND1 a nd EMS1 (P = .05) correlated with nodal metastasis. The combination of an inflammatory reaction, eosinophilic infiltration, and staining for Rb and Ep-CAM resulted in a superior accuracy in assessing nodal meta stasis. Conclusions: These results indicate that it is possible to pre dict and exclude lymph node metastasis by studying the features of the primary tumor only. When these results are confirmed in a larger seri es, biological markers may be powerful diagnostic tools with great imp act on clinical decision making.