Abstract
ABSTRACTOur previous study by Murakami N, Mori T, Nakamura S, Yoshimoto S, Honma Y, Ueno T, Kobayashi K, Kashihara T, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. (J Radiat Res. 2019 Jul 30. pii: rrz053. doi: 10.1093/jrr/rrz053. [Epub ahead of print]) showed that strong expression of epithelial cell adhesion molecule (EpCAM) was associated with radiation resistance in head and neck squamous cell cancer patients (SCC). In this study, the prognostic impact of histopathologic features including EpCAM for nasopharyngeal cancer (NPC) patients was investigated. Since 2009, our institution has performed chemoradiation for locally advanced NPC patients with intensity modulated radiation therapy (IMRT). Tri-weekly adjuvant cisplatin (CDDP, 80 mg/m2) was administered concurrently with definitive radiation therapy 70 Gy in 35 fractions. One month after radiation therapy, adjuvant chemotherapy of three cycles of CDDP/5 fluorouracil (5-FU) was administered. Using a pretreatment biopsy specimen, EBV-encoded small RNA in situ hybridization (EBER-ISH), EpCAM, p16 and p53 were assessed by immunohistochemical analysis. Between May 2009 and September 2017, 51 NPC patients received definitive radiation therapy. Five, 13, 17 and 16 patients were staged as I, II, III and IV, respectively. The median follow-up period for alive patients was 31.1 months (12.4–109.7 months). Three-year overall survival (OS), progression-free survival (PFS) and locoregional control (LRC) were 87.1, 57.1 and 85.7%, respectively. EpCAM, p16 and p53 were not associated with PFS, OS nor LRC. Three-year PFS for patients with keratinizing and non-keratinizing SCC were 25 and 60.5%, respectively (P = 0.033, hazard ratio 4.851 (95% confidence interval 1.321–17.814)).Prognosis of NPC patients with keratinizing SCC was worse than non-keratinizing SCC patients, suggesting a biological difference between the two types of tumor.
Highlights
Our previous report demonstrated that overexpression of epithelial cell adhesion molecule (EpCAM) was associated with local recurrence after definitive radiation therapy for early-stage glottic cancer patients [15], and in other head and neck sites that consisted mostly of hypopharynx, oropharynx and larynx, we showed that EpCAM was a prognostic factor [16]
In this single institutional retrospective study, authors investigated the relationship between clinicopathologic features including EpCAM and clinical outcome for nasopharyngeal cancer (NPC) patients treated with definitive chemoradiation therapy
13, 17 and 16 patients were classified into Stage I, II, III and IVA, respectively. 92.1% of patients were non-keratinizing type squamous cell cancer patients (SCC) and 85.1% of the nonkeratinizing type were positive for EBV-encoded small RNAs (EBERs)-in situ hybridization (ISH)
Summary
While nasopharyngeal cancer (NPC) is commonly seen in China [1, 2] and Southeast Asia [3, 4], it is rarely seen in the rest of the non-endemic world including Japan [5].The development of non-keratinizing squamous cell carcinoma (SCC), the predominant type of NPC, is related to Epstein-Barr virus (EBV) infection, and EBV screening is used for disease detection in endemic regions [6, 7].Intensity modulated radiation therapy (IMRT) has been used for NPC patients to protect major salivary glands, spinal cord, constrictor muscle and thyroid gland to maintain the patient’s later organ function and contribute to maintaining quality of life [8,9,10].The epithelial cell adhesion molecule (EpCAM) or CD326 is a 30–40 kDa glycosylated type I membrane protein [11]). It is related to cellular signaling, cell migration, differentiation and proliferation [13] In pathologic circumstances such as malignancies and inflammatory responses, its expression can be increased [14]. Our previous report demonstrated that overexpression of EpCAM was associated with local recurrence after definitive radiation therapy for early-stage glottic cancer patients [15], and in other head and neck sites that consisted mostly of hypopharynx, oropharynx and larynx, we showed that EpCAM was a prognostic factor [16]. The prognostic role of EpCAM is undetermined in NPC [19] In this single institutional retrospective study, authors investigated the relationship between clinicopathologic features including EpCAM and clinical outcome for NPC patients treated with definitive chemoradiation therapy
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