Abstract
p53, c-erbB-2 and epidermal growth factor receptor (EGFR) are cancer-related proteins that are usually expressed in head and neck squamous cell carcinoma (SCC). Their prognostic value remains controversial. To evaluate the prognostic impact of p53, c-erbB-2 and EGFR expression in head and neck SCC. Prospective. Head and Neck Surgery Department, Hospital AC Camargo, São Paulo. Fifty-four patients were studied for p53, c-erbB-2 and EGFR expression in head and neck SCC and adjacent mucosa, via immunohistochemistry. These data were correlated with histoclinical data and survival. There was a direct association of p53 expression in SCC and mucosa (p = 0.001); loss of c-erbB-2 expression (-) from normal mucosa to SCC (p = 0.04); lower frequency of association of c-erbB-2 (+) with EGFR (-) in SCC (p = 0.02); and a direct association of EGFR (+) expression in SCC and mitotic index (p = 0.03). The 60-month actuarial survival rates for patients presenting lymph node metastasis were higher when there was no capsule rupture by SCC (48.3%; p = 0.02), no more than one positive lymph node (52.3%; p = 0.004) or clear surgical margins (47.0%; p = 0.01), in comparison with patients presenting capsule rupture (20.2%), two or more positive lymph nodes (18.7%) or compromised surgical margins (0.0%), respectively. Patients presenting SCC p53 (+) and EGFR (-) demonstrated greater survival (75.0%; p = 0.03) than for the remaining group (33.1%). Multivariate analysis confirmed the positive impact of p53 (+) and EGFR (-) on survival (p = 0.02). Associations were found for p53, c-erbB-2 and EGFR expression with histoclinical data and prognosis. Interestingly, these results suggest that loss of mucosal c-erbB-2 expression could be involved in SCC carcinogenesis; EGFR expression in SCC is related to tumor mitotic index; and presence of p53 with absence of EGFR expression in head and neck SCC may be a prognostic factor for survival. Further prospective studies should be conducted to confirm the influence of p53, c-erbB-2 and EGFR on histoclinical data and prognosis.
Highlights
Head and neck squamous cell carcinomas (SCC) are associated with smoking and alcohol consumption and are often preceded by preneoplastic lesions
There was a direct association of p53 expression in SCC and mucosa (p = 0.001); loss of c-erbB-2 expression (-) from normal mucosa to SCC (p = 0.04); lower frequency of association of c-erbB-2 (+) with epidermal growth factor receptor (EGFR) (-) in SCC (p = 0.02); and a direct association of EGFR (+) expression in SCC and mitotic index (p = 0.03)
These results suggest that loss of mucosal c-erbB-2 expression could be involved in SCC carcinogenesis; EGFR expression in SCC is related to tumor mitotic index; and presence of p53 with absence of EGFR expression in head and neck SCC may be a prognostic factor for survival
Summary
Head and neck squamous cell carcinomas (SCC) are associated with smoking and alcohol consumption and are often preceded by preneoplastic lesions. Many reviews have confirmed its crucial role in carcinogenesis as a tumor suppressor gene, but its value as a prognostic factor for head and neck squamous cell carcinomas remains controversial.[1,2,3] It is generally accepted that p53 hyperexpression is the consequence of an increase in the half-life of the non-functional p53 protein. This is usually related to a mutation of the gene and is detectable via immunohistochemistry. In head and neck squamous cell carcinomas of the oral cavity, overexpression of the c-erbB-2 has been correlated with shorter overall survival.[5]
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