Diagnosis of second head and neck tumors in primary laryngeal SCC is an indicator of overall survival and not associated with poorer overall survival: a single centre study in 987 patients.

OBJECTIVES: Second primary tumors (SPTs) have been implicated in poor overall survival (OS) of head and neck squamous cell carcinomas (HNSCCs). Confusion remains regarding their actual incidence and prognostic impact. This study assessed the incidence of SPTs; the SPT diagnostic time lag; the impact on OS; and the mean annual risk. METHODS: Nine hundred eighty seven consecutive patients treated for primary larynx SCC (1967-2004) were analyzed in this study. 96.3% and 91.4% of patients reached a minimum follow-up period of 3 and 5 years. RESULTS: Two hundred eight (21.1%) patients were diagnosed with SPTs. One hundred forty three (14.5%) patients developed upper aero-digestive tract (UAD)-SPTs, 83 (8.4%) were HNSCCs, 56 (5.7%) were lung, and 4 (0.41%) were esophageal-SPTs. Survival analysis demonstrated clear superior OS rates for the UAD-SPT (P < 0.008) and HNSCC-SPT (P < 0.001) groups. A comparison of survival of subgroups showed lung/esophagus to have a poorer survival when compared to all other subgroups. OS after diagnosis of an SPT was poorer when compared with no-SPT group (P < 0.001). The mean annual risk of developing UAD-SPTs was 2.4%. CONCLUSION: These results suggest that HNSCC-SPT should not be viewed as an adverse prognostic factor. Reclassifications of UAD-SPTs into HNSCC-SPT and non-HNSCC-SPT better reflects their clinical behavior and prognosis.

Protein expression of epidermal growth factor receptor in laryngeal squamous cell carcinoma index tumors correlates with diagnosis of second primary tumors of the upper aero-digestive tract.

BACKGROUND: Field cancerization is a feature of HNSCCs. No biological marker in the index tumor has correlated with second primary tumor (SPTs) development. Changes in MDM-2 and epidermal growth factor receptor (EGFR) expression are known to be early neoplastic changes in HNSCC. EGFR expression is correlated with clinical outcomes. This study has assessed the predictive correlation of MDM-2 and EGFR protein expression with clinicopathological parameters and occurrence of SPTs in HNSCC. METHODS: Using immunohistochemistry, 106 patients who were treated for primary laryngeal squamous cell carcinoma were investigated for expression of MDM-2 and EGFR. RESULTS: Positive expression of MDM-2 and EGFR was found in 51 of 106 (48.1%) and 82 of 106 (77.4%) cases, respectively. EGFR expression was found to correlate with diagnosis of new primary tumors (P = 0.003), disease-free survival (P = 0.008), as well as overall survival (P = 0.003). MDM-2 expression correlated with nodal relapse (P = 0.03). CONCLUSIONS: SPTs relate to poor prognosis in HNSCC, indicating that closer clinical surveillance of this patient group would be beneficial. Examination of the expression of EGFR by the primary tumor could have potential clinical benefits because this study suggests that it may become a vital biomarker for patients who are most at risk of developing SPTs.

Radiotherapy is not associated with an increased rate of Second Primary Tumours in Oral Squamous Carcinoma: a study of 370 patients.

Oral Squamous Cell Carcinoma (OSCC) remains a public health scourge. Radiotherapy (RT) is a major treatment modality and has been implicated in possible formation of Second Primary Tumours (SPT). In a single centre retrospective study of 370 patients with OSCCs (1967-2004) associations between RT, diagnosis of SPTs, median SPT diagnostic time lag, Disease Free Survival (DFS) and overall survival (OS) were analysed. Sixty-eight (18.4%) patients developed metachronous SPTs. Two hundred and twenty patients (59.3%) underwent some form of RT whilst 151 (40.7%) patients were not exposed to RT. No significant increased incidence of SPTs was demonstrated in the RT group. No significant difference in SPT diagnostic time lag was noted amongst the groups. This study suggests that RT is neither a risk for SPT induction nor increases the relative diagnostic time delay of upper aero-digestive tract SPTs.