The diagnostic value of 11q13 amplification and protein expression in the detection of nodal metastasis from oral squamous cell carcinoma: a systematic review and meta-analysis.

Rob Noorlag,Inge Stegeman,Pauline M W Van Kempen,Stefan M Willems,Ron Koole,Robert J J Van Es

doi:10.1007/s00428-015-1719-6

Abstract

Despite improvements in both diagnostic and therapeutic strategies, the prognosis of oral squamous cell carcinoma (OSCC) has not changed significantly over the last decades. Prognosis of OSCC particularly depends on the presence of nodal metastasis in the neck. Therefore, proper determination of the nodal status is pivotal for appropriate treatment. Unfortunately, current available imaging techniques (magnetic resonance imaging or ultrasound even with fine needle aspiration of suspected lymph nodes (LNs)) fail to detect occult nodal disease accurately. Clinicians in head and neck oncology urgently need new diagnostic tools to reliably determine the presence of nodal metastasis of the neck. Gain of the chromosomal region 11q13 is one of the most prominent genetic alterations in head and neck cancer and is associated with poor prognosis and metastasis. The aim of this systematic review and meta-analysis was to determine the diagnostic value of either 11q13 amplification or amplification/protein overexpression of individual genes located on 11q13 to detect nodal metastasis in OSCC. A search was conducted in Pubmed, EMBASE, and Cochrane, and 947 unique citations were retrieved. Two researchers independently screened all articles and only 18 were found to meet our inclusion criteria and were considered of sufficient quality for meta-analysis. Pooled results of those show that both amplification of CCND1 and protein overexpression of cyclin D1 significantly correlate with lymph node metastasis (LNM) in OSCC. In addition, amplification of CCND1 shows a negative predictive value of 80 % in the detection of LNM in early stage OSCCs which are clinically lymph node negative although this evidence is sparse and should be validated in a larger homogeneous cohort of T1-2 OSCC.Electronic supplementary materialThe online version of this article (doi:10.1007/s00428-015-1719-6) contains supplementary material, which is available to authorized users.

Highlights

Head and neck cancer is a heterogeneous group of malignancies and the sixth most common malignancy worldwide [1]
New diagnostic biomarkers to improve the diagnosis of nodal metastasis in patients with oral squamous cell carcinoma (OSCC) are pivotal for a better and more individualized treatment of the neck [3]
Amplification of 11q13 is common in head and neck cancer, and several studies showed a correlation with metastasis and poor survival

Summary

Introduction

Head and neck cancer is a heterogeneous group of malignancies and the sixth most common malignancy worldwide [1]. Current available imaging techniques such as magnetic resonance imaging (MRI) or even ultrasound with fine needle aspiration of suspected lymph nodes fail to detect the presence of nodal metastasis accurately; 30 to 40 % of patients with clinically lymph node negative neck have occult nodal metastasis and will develop nodal disease if the neck is left untreated [3]. This urges for better diagnostic tools to detect regional metastasis more accurately.

Methods

Results

Conclusion