Cao. Nathan et al., Analysis of surgical margins with the molecular marker eIF4E: A prognosticfactor in patients with head and neck cancer, J CL ONCOL, 17(9), 1999, pp. 2909-2914
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.