PROGNOSTIC-SIGNIFICANCE OF DNA FLOW CYTOMETRIC ANALYSIS IN PATIENTS WITH NASOPHARYNGEAL CARCINOMA

BACKGROUND. Nasopharyngeal carcinoma (NPC) is a prevalent malignant tu mor among Southern Chinese. Previously, the authors described the prog nostic significance of a serum antibody assay to a recombinant Epstein -Barr virus Bam HI-Z replication activator protein (ZEBRA) in NPC pati ents with long term follow-up. In same series. METHODS. One hundred an d forty-three archival biopsies from 110 NPC patients were deparaffini zed and subjected to DNA-FCM analysis. DNA ploidy state and various pr oliferative indices (PI) of the tumors were correlated with patient su rvival and frequency of recurrence. RESULTS, Among the biopsies analyz ed, 119 were histologically positive NPC and 24 were negative. Fifty-o ne tumor biopsies that fulfilled the guideline criteria of the DNA Cyt ometry Consensus Conference were correlated with the clinical manifest ations of the patients. Among them, 43 tumors (84%) were DNA diploid a nd 8 (16%) were aneuploid. TWO PI, S-phase fraction (SPF) and prolifer ation fraction (PF), appear to be potentially useful prognostic indica tors. For example, PF in patients who developed locoregional recurrenc e (15.1%) and distant recurrence (16.4%) after radiation therapy both were significantly higher than PF in patients who were in complete rem ission (8.2%) (P = 0.0005 and P = 0.004, respectively). Significant di fferences in SPF between patients with distant recurrence (10.6%) and those in remission (5.7%) also was found (P = 0.005). Using Kaplan-Mei er analysis, patients With high PF, high SPF, and aneuploid tumors had significantly poorer 12-year survival rates (35%, 26%, and 28%, respe ctively) than those patients with low PF, low SPF, and diploid tumors (77%, 67%, and 59%, respectively) (P < 0.0009, P < 0.004, and P < 0.01 , respectively).CONCLUSIONS. Determination of tumor PI and DNA ploidy state by DNA-FCM at diagnosis of NPC can be potentially useful in sele cting a poor prognostic subgroup of NPC patients. These parameters may enable oncologists to plan for more stringent treatment strategies su ch as hyperfractionated and accelerated radiation therapy or concomita nt chemoradiotherapy for these patients. (C) 1998 American Cancer Soci ety.