Novel prognostic factors in laryngeal carcinoma patients

Hintergrund. Die Behandlungsmöglichkeiten des Larynxkarzinoms umfassen Strahlentherapie, offen Chirurgie und transorale Lasermikrochirurgie (TLM). Die derzeitige Studienlage zeigt ähnliches Überleben unabhängig von der Behandlungsmethode. Wir untersuchten das klinische Ergebnis von Patienten mit glottischen und supraglottischen Plattenepithelkarzinomen, welche mit TLM an der Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde an der Medizinischen Universität Wien zwischen 1994 und 2012 behandelt wurden. Das „engulfment and cell motility” Protein 3 wurde mit Tumorgröße, Stadium und der Metastasierung von nicht-kleinzelligen Lungenkarzinomen beschrieben. Bisher wurde dies allerdings noch nicht bei Kopf/Hals - Malignomen erforscht. Wir untersuchten daher seine prognostische Relevanz für das Überleben in Patienten mit frühen glottischen Larynxkarzinomen. Methoden. Wir führten eine retrospektive Analyse von an unserer Klinik mit TLM erstbehandelten Patienten durch. Aus der gesamten Studienkohorte wurden Patienten mit T1N0M0 glottischen Karzinomen identifiziert und die histologischen Paraffin fixierten Proben untersucht. Es wurden immunhistochemische Färbungen für das ELMO3 Protein in dem Primärtumor durchgeführt und mit den klinischen Daten korreliert. Ergebnisse. Insgesamt 112 Patienten (37 supraglottische und 75 glottische) wurden mit einer medianen Nachbeobachtungszeit von 92 Monaten eingeschlossen. Das mittlere Alter bei der Behandlung waren 61 Jahre. Das 5- und 10-Jahres Gesamtüberleben war 75% und 50%, während das 5- und 10-Jahres krankheitsfreie Überleben 60% und 40%. Betrug. 23% der 48 glottischen Karzinompatienten waren 8 ELMO3 positiv, welches mit schlechten krankheitsspezifischen und krankheitsfreien Überleben (p <0,05) korrelierte. Zusammenfassung. Lokoregionale Kontrolle, das krankheitsfreie Überleben und das Gesamtüberleben in unserer Studie waren vergleichbar mit der aktuellen Literatur. Des Weiteren konnte die Expression von ELMO3 als prognostischer Faktor bei Patienten mit frühem glottischen Larynxkarzinom identifiziert werden.Background. Transoral laser microsurgery (TLM) has become a standard alternative treatment to radiotherapy and open surgery in patients with laryngeal cancer. Currently available data does not distinctly favor one treatment modality over the other. We aimed to assess the clinical outcome in patients with glottic and supraglottic squamous cell carcinoma treated with TLM at the Department of Otorhinolaryngology, Head and Neck Surgery at the Medical University of Vienna between 1994 and 2012. The engulfment and cell motility 3 (ELMO3) protein expression has been correlated with tumor size, TNM stage, lymph node metastases and distant metastases in non-small cell lung cancer, but has not been investigated in head and neck cancers. We therefore aimed to identify its prognostic relevance in patients with early glottic cancer. Methods. We conducted a retrospective medical chart review of previously untreated glottic and supraglottic squamous cell carcinoma patients who underwent transoral laser microsurgery. Out of this study cohort, patients with T1N0M0 glottic cancer were identified and histologic paraffin-embedded specimens retrieved. Immunohistochemistry staining for ELMO3 was performed in the primary tumor and correlated with clinical outcome. Results. Overall 112 patients (37 supraglottic and 75 glottic) were included with a median follow-up time of 92 months. The median age at treatment was 61 years. The 5- and 10-year overall survival was 75% and 50%, whereas the 5- and 10-year disease-free survival was 60% and 40%. In 48 glottic cancer patients ELMO3 expression was positive in 23% of the specimen, which was correlated with poor disease-specific and disease free survival (p < 0.05). Conclusion. Locoregional control, disease-free survival and overall survival in our study population were comparable to current literature. Furthermore ELMO3 might serve as future prognostic biomarker in patients with early glottic cancer.submitted by Dr. med.univ. Georg HaymerleZusammenfassung in deutscher SpracheAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersMedizinische Universität, Dissertation, 2017OeB

Risk factors for acute unplanned tracheostomy during panendoscopy in HNSCC patients.

BackgroundDespite of careful pre-operative risk evaluation some patients require an acute unplanned tracheostomy during panendoscopy.MethodsRisk factors of patients requiring an unplanned tracheostomy during panendoscopy (n = 32) were compared to a control group with panendoscopy without tracheostomy (n = 180).Results2131 panendoscopies for Head and Neck squamous cell carcinoma were performed at our Department between 2000 and 2014. Unplanned tracheostomies were necessary in 1.6% of all panendoscopies. Patients with laryngeal cancer (p = 0.001) or abnormal activated partial thromboplastin time (aPTT) (p = 0.03) had a statistically significant higher risk of unplanned tracheostomy. Regression analysis showed that patients with advanced laryngeal cancer had an almost 6 times higher risk for tracheostomy than patients with early stage oropharyngeal cancer.ConclusionsWe identified abnormal aPTT and laryngeal carcinoma as significant predictors for unplanned tracheostomy during panendoscopy. The results of our study could improve preoperative risk evaluation in HNSCC patients

Expression of Merkelcell polyomavirus (MCPyV) large T-antigen in Merkel cell carcinoma lymph node metastases predicts poor outcome.

The aim of this study was to determine the prevalence of MCPyV in Merkel cell carcinoma (MCC) primaries versus lymph node metastasis and to evaluate possible prognostic factors.Samples of MCC primaries and lymph node metastases were stained immunohistochemically for the MCPyV large T-antigen and expression was compared to patients´ clinical outcome.41 MCC patients were included. 33 (61%) out of 54 specimens were MCPyV-positive in the immunohistochemistry. 15 (47%) out of 32 primary tumors were positive compared to 18 (82%) out of 22 lymph node metastases. Eleven patients with positive polyomavirus expression died from the carcinoma compared to 4 patients without virus expression. Cox regression analysis showed worse disease-free survival in patients with MCPyV compared to virus-negative lymph nodes (p = 0.002).To our knowledge this is the first study to describe a negative prognostic effect of the MCPyV expression in lymph node metastasis in MCC patients

Expression of Merkelcell polyomavirus (MCPyV) large T-antigen in Merkel cell carcinoma lymph node metastases predicts poor outcome - Fig 3

<p>Kaplan-Meier survival curves depict disease-free survival of 41 MCC patients according to tumor stage (Fig 3A) and tumor localization (Fig 3B). Patients with higher tumor staging survived significantly shorter (p < 0.001) whereas patients with MCCUP had a better outcome than patients with primary tumors of the head and neck region, the trunk or the extremities (p = 0.268).</p

MCPyV status and clinicopathologic data of 41 patients with Merkel cell carcinoma.

<p>MCPyV status and clinicopathologic data of 41 patients with Merkel cell carcinoma.</p

Immunohistochemistry of MCPyV large T-antigen (LTA) and outcome data in 54 specimens from 41 patients with Merkel cell carcinoma.

<p>Immunohistochemistry of MCPyV large T-antigen (LTA) and outcome data in 54 specimens from 41 patients with Merkel cell carcinoma.</p

Five samples, which were negative and 5 samples, which showed positive immunostaining, were used for PCR.

<p>The MLK1 Merkel cell carcinoma cell line was used as positive control for the establishment of the MCPyV PCR (Fig 2).</p

Disease-free survival (DFS) stratified by expression of the MCPyV large T-antigen (LTA) in lymph node metastases.

<p>Patients with LTA-positive (green line) MCC lymph node metastases had a shorter DFS (p = 0.002)(Fig 4A) and OS (p = n.s.)(Fig 4B) than patients with LTA-negative (blue line) lymph nodes. (n.s. = not significant).</p