[Prognostic value of the urokinase-type plasminogen activator and its inhibitors in squamous cell carcinoma of human larynx].

OBJECTIVE

The aim of the present study was to evaluate whether the expression of uPA parameters might be of clinical value in squamous cell carcinoma of human larynx as a tumor/biologically defined risk factor.

METHOD

In a consecutive series of 127 patients resected for primary squamous cell carcinoma of human larynx, the expression of uPA and plasminogen activator inhibitors (PAI) type-1, type-2 was determined immunohistochemically. The results were classified as positive and negative. Patients were followed-up prospectively for a median of 41 months(rang 6 to 84 months). Overall survival were analyzed according to Kaplan-Meier and log-rank statistics, the prognostic relevance of uPA, PAI-1, PAI-2 and conventional prognostic factors were analyzed by Cox analyses.

RESULT

These revealed a high significant inverse correlation of uPA positive expression survival time(P = 0.006); and patients with PAI-2 positive expression had a significantly longer survival time than those with PAI-2 negative expression(P = 0.009); in different clinicopathological parameters subgroups uPA, PAI-2 added significant survival information, whereas PAI-1 positive expression did not associate with prognoses. Patients with uPA-positive/PAI-2-negative expression had the poorest prognoses. Multivariate analysis revealed that four independent prognostic factors for overall survival time were uPA, PAI-2, lymph node metastasis and differentiation of tumor, P = 0.0002, 0.0001, 0.0117, 0.0436 respectively, relative risk and 95% confidence interval were 1.99 (1.39 to 2.85) 0.36 (0.212 to 0.609), 2.36 (1.21 to 4.61) 1.51 (1.01 to 2.25) respectively.

CONCLUSION

We conclude that uPA and PAI-2 are new independent and strong biologically prognostic factors, uPA positive expression may be a powerful aid in evaluating metastatic potential and high risk patients in early stage of human larynx carcinoma.