Abstract
Small pretreatment laryngeal biopsies may not fully represent a tumor’s biological profile. This study on laryngeal squamous cell carcinoma (LSCC) aimed to investigate the prognostic role of CD105- and CD31-assessed microvessel density (MVD) in paired biopsies and surgical specimens and the association and discrepancy between CD105- and CD31-assessed MVD in biopsies and surgical specimens. CD105- and CD31-assessed MVD was analyzed in paired biopsies and surgical specimens of 45 consecutive cases of LSCC. In the LSCC biopsies and surgical specimens, median CD105-assessed MVD was significantly higher in N+ than in N0 cases (p = 0.0008, and p = 0.0002, respectively). Disease-free survival (DFS) was associated with CD105- and CD31-assessed MVD in both biopsies and surgical specimens (p < 0.0001 for all specimens). Multivariable Cox’s regression showed that pathological grade (p < 0.0001) and CD105-assessed MVD in LSCC biopsies (p = 0.0209) predicted DFS. Lin’s concordance coefficient showed that CD31 overestimated MVD compared with CD105 in LSCC biopsies and surgical specimens. CD105-assessed MVD should be further investigated in larger LSCC series as a potential prognostic marker for identifying: patients at higher risk of recurrence who might warrant more aggressive therapy; and cN0 patients requiring elective neck dissection for a significant risk of regional metastasis.
Highlights
Despite advances in diagnostics and treatments, the prognosis for laryngeal squamous cell carcinoma (LSCC) has seen little improvement in the last three decades, with a 5-year survival rate of 60.9% [1]
MVD: microvessel density; SD: standard deviation; IQR: interquartile range; HR: hazard ratio; 95% CI: 95%
Considering limited available data, it is still doubtful whether the results of immunohistochemistry performed on head and neck cancer biopsy material in the diagnostic phase can be used in clinical decision making; well-known head neck carcinoma heterogeneity [14] raises the concern that immunohistochemistry methods may not be accurate on small biopsy specimens
Summary
Despite advances in diagnostics and treatments, the prognosis for laryngeal squamous cell carcinoma (LSCC) has seen little improvement in the last three decades, with a 5-year survival rate of 60.9% [1]. A thorough understanding of the molecular mechanisms behind LSCC is imperative to improve patient survival, in cases of advanced disease. Several signals capable of tripping the “angiogenic switch” have been identified, including gene mutations involved in activating oncogenes and deleting tumor suppressor genes, as well as oxidative and mechanical stress and hypoxia [2,3]. Evidence of the stimulation of pro-angiogenic molecules can be seen in tumor cells. Metastasis occurs when angiogenic factors in the tumor micro-environment are overexpressed, facilitating the detachment of tumor cells and their migration via blood and lymph vessels [3]. Epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 2, endoglin (CD105), angiogenin, hypoxia-inducible factor 1, angiopoietin, inducible nitric oxide synthetase, cytochrome
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