Analysis of surgical margins with the molecular marker eIF4E: A prognosticfactor in patients with head and neck cancer

Purpose: Complete excision of cancer is guided by histologic assessment of surgical margins. Molecular markers may be more sensitive in identifying ma lignant cells. elF4E, a eukaryotic protein synthesis initiation factor, is Found elevated in all head and neck squamous cell cancers (HNSCC). In a pre liminary study using Western blots and a retrospective study using immunohi stochemistry, elF4E elevation in histologically tumor-free surgical margins correlated with a higher local-regional recurrence. We wanted to confirm t his hypothesis in a prospective study. Patients and Methods: Immunohistochemical analysis of surgical margins and tumors with an antibody to elF4E was performed on all newly diagnosed HNSCC patients who underwent surgical resection for their disease between Januar y 1996 and December 1997. Results: All 65 patients had elevated levels of elF4E in the tumors, Thirty -six patients (55%) had elevated elF4E in histologically tumor-free margins , and 20 of these patients (56%) have had local-regional recurrrences. Twen ty-nine patients (45%) had no elevation of elF4E in the margins, and only t wo of these patients (6.9%) have had recurrences. Cox regression analysis s howed that elevated elF4E in the margins was an independent prognostic fact or (P = .009) for recurrence. The Kaplan-Meier curves for the probability o f nonrecurrence were significantly different for positive and negative elF4 E margins (P = .0001, log-rank test). Conclusion: In histologically rumor-free surgical margins, elevated levels of elF4E predict a significantly increased risk of recurrence. Elevated lev els of elF4E in tumor margins may identify patients who could benefit from additional therapy. (C) 1999 by American Society of Clinical Oncology.