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Clinical Significance of Micrometastatic Cells Detected by E48 (Ly-6D) Reverse Transcription-Polymerase Chain Reaction in Bone Marrow of Head and Neck Cancer Patients
Purpose: Despite improvements in locoregional treatment of head and neck squamous cell carcinoma (HNSCC), local and distant failure rates remain high. The strongest prognostic indicator of HNSCC is the presence of lymph node metastases in the neck, but the value of this indicator has limitations whe...
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Published in: | Clinical cancer research 2004-12, Vol.10 (23), p.7827-7833 |
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Main Authors: | , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Purpose: Despite improvements in locoregional treatment of head and neck squamous cell carcinoma (HNSCC), local and distant failure
rates remain high. The strongest prognostic indicator of HNSCC is the presence of lymph node metastases in the neck, but the
value of this indicator has limitations when using for the individual patient. The presence of micrometastatic cells in bone
marrow has been shown to be a putative prognostic indicator in HNSCC and other epithelial malignancies, which might allow
more accurate staging and selection of patients for whom adjuvant or experimental therapy is recommended. The gene encoding
the E48 antigen is selectively expressed by HNSCC, and the detection of E48 transcripts in bone marrow by reverse transcription-polymerase
chain reaction (RT-PCR) presumably represents the presence of micrometastatic cells. The purpose of this study was to determine
the association between the presence of micrometastatic cells in bone marrow of HNSCC patients and clinical outcome.
Experimental Design: A total of 162 patients treated surgically for primary HNSCC underwent a single bone marrow aspiration from the upper iliac
crest for detection of micrometastatic cells using E48 RT-PCR. In total, 139 patients were evaluable. The primary statistical
endpoints were disease-free survival and distant metastasis-free survival. In addition, bone marrow samples of 30 noncancer
controls were evaluated.
Results: E48 RT-PCR indicated the presence of micrometastatic cells in the bone marrow in 56 of 139 (40%) of the HNSCC patients and
0 of 30 of the noncancer controls ( P < 0.0001). The presence of micrometastatic cells had no significant influence on disease-free survival or distant metastasis-free
survival for the whole group of HNSCC patients ( P = 0.1460 and P = 0.2912, respectively). For patients with ≥2 lymph node metastases, however, the presence of micrometastatic cells was associated
with a poor distant metastasis-free survival ( P = 0.0210).
Conclusions: The presence of micrometastatic cells in bone marrow of HNSCC patients with ≥2 lymph node metastases is correlated with a
poor distant metastasis-free survival. In this subgroup of HNSCC patients, E48 RT-PCR seems to be a valuable tool to identify
patients who are at increased risk for development of distant metastases and therefore might benefit from experimental adjuvant
systemic therapy. |
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ISSN: | 1078-0432 1557-3265 |
DOI: | 10.1158/1078-0432.CCR-04-1090 |