RESUMO
BACKGROUND: p16 has been indicated as a suitable surrogate biomarker of HPV infection. The prognosis of p16-positive oropharynx tumors (OTs) of squamous cell carcinoma (SCC) histology is better than that of p16-negative tumors. METHODS: We analyzed 209 samples of head and neck SCC to establish a predictive cutoff for p16 and determine the role of p16 positivity in OTs versus non-OTs. We compared the outcomes of tumors harboring any percentage of p16-positive cells (≥1%) with those of p16-negative OTs. We then considered 3 cutoffs (10%, 50% and 70% positive cells) to evaluate the outcome of OTs/non-OTs with similar p16 expression and p16-positive versus p16-negative tumors stratified by patient age. RESULTS: p16-negative tumors among OTs and non-OTs were 29% and 49%, respectively (p = 0.0054). The cumulative distribution showed that the positive values were located around 2 focus points: 2% and 96%. Subgroup analysis showed that only OTs occurred in young patients (aged <65 years) and that there was a ≥70% gain in survival in cases with p16-positive cells. CONCLUSIONS: p16 positivity influences outcome only in young patients and OTs (p = 0.048).
Assuntos
Biomarcadores Tumorais/biossíntese , Carcinoma de Células Escamosas/genética , Neoplasias de Cabeça e Pescoço/genética , Proteínas de Neoplasias/biossíntese , Fatores Etários , Idoso , Biomarcadores Tumorais/genética , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Inibidor p16 de Quinase Dependente de Ciclina , Receptores ErbB/biossíntese , Receptores ErbB/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Papillomaviridae/genética , Papillomaviridae/patogenicidade , Prognóstico , Resultado do TratamentoRESUMO
OBJECTIVE: To compare virtual endoscopy (VE) with flexible endoscopy in patients with cancer of the larynx. STUDY DESIGN AND SETTINGS: This prospective study includes 24 patients with proven cancer of the larynx. Patients underwent spiral CT according to our standard protocol for upper airway imaging. This same set of axial scans was transferred to a dedicated workstation to obtain VE images. Results of VE were compared with the findings of flexible endoscopy. RESULTS: Quality of the examination was good in 96% of the patients. VE identified all exophytic lesions. Two small flat lesions could be observed as slightly enhanced plaques only on the axial scans. Subglottic extension was correctly demonstrated in all cases by associating VE to the axial scans. CONCLUSION: VE shows high sensitivity in the identification of exophytic lesions of the larynx and can establish relationships between cancer and nearby structures. It can be performed in the presence of severe stenosis and does not require sedation and additional scanning. On the other hand, VE show limits in the identification of flat lesions and does not allow biopsies and functional imaging to be performed. SIGNIFICANCE: VE is a useful tool for staging and presurgery treatment of cancer of the larynx.
