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Neoplasma Vol.52, p.199-207, 2005 |
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Title: Prognostic significance of mitotic and apoptotic index and the DNA cytometry in head and neck cancer | ||
Author: P., SMILEK ; L., DUSEK ; K., VESELY ; J., ROTTENBERG ; R., KOSTRICA ; | ||
Abstract: The lack of suitable criteria to predict the response to chemo-
and or radiotherapy for individual patients with squamous
cell carcinoma of the head and neck (HNSCC) remains still a major
problem. This study was conducted to analyze prognostic
significance of mitotic and apoptotic index and the DNA flow
cytometric analysis of HNSCC to the recurrence-free survival
time and to the overall survival. The analysis was carried out in
a set of 56 patients suffering from carcinoma of the
pharynx and supraglottis. Most patients (96.7%) underwent
neoadjuvant chemotherapy, followed by surgery and postoperative
irradiation. Besides routine examinations, flow cytometric
analysis was performed, as well as p53 and Ki-67 markers
and mitotic and apoptotic index were established by means of
immunohistochemistry. Event-free survival (EFS) and overall
survival (OS) were accepted as primary endpoints for the
prognostic analyses. All the examined potential markers entered
standard Kaplan-Meier survival analysis and Cox regression
modeling. Statistical significance of prognostic factors was
first examined in univariate models and all the parameters
subsequently entered multivariate models.
The analyses revealed significant prognostic position of advanced
clinical stage (III+IV) and increased proliferative activity
as primary risk factors (p<0.01) that typically positively
correlate with increased mitotic activity and G2/M cell fraction.
Better survival results obtained for grade 3–4 as compared to
grade 1–2 were caused by molecular parameters that
make these samples similar to less risk cases. Cytokinetic
parameters and proliferation activity were found as important
predictors
of the second level (after recognizing stage, grade and DNA status
of the tumor). Multivariate combination of these
markers contributed namely to the prognosis of early risk event: a
ratio S phase cell fraction/G2M cell fraction was found to
be the key prognostic factor (p<0.01). Early risk events are
associated with increased mitotic activity, decreased apoptic
rate, decreased S phase cell fraction and significantly increased
G2/M fraction.
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Keywords: head & neck cancer, risk prognosis, mitotic/apoptotic index, DNA cytometry | ||
Year: 2005, Volume: 52, Issue: | Page From: 199, Page To: 207 | |
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