Department of Radiation Oncology, Center of Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
Int J Radiat Oncol Biol Phys. 2010 Jun 1;77(2):438-46. doi: 10.1016/j.ijrobp.2009.05.021. Epub 2009 Sep 3.
To determine the prognostic and predictive values of molecular marker expression profiles based on data from a randomized clinical trial of postoperative conventional fractionation (p-CF) therapy versus 7-day-per-week postoperative continuous accelerated irradiation (p-CAIR) therapy for squamous cell cancer of the head and neck.
Tumor samples from 148 patients (72 p-CF and 76 p-CAIR patients) were available for molecular studies. Immunohistochemistry was used to assess levels of EGFR, nm23, Ki-67, p-53, and cyclin D1 expression. To evaluate the effect of fractionation relative to the expression profiles, data for locoregional tumor control (LRC) were analyzed using the Cox proportional hazard regression model. Survival curves were compared using the Cox f test.
Patients who had tumors with low Ki-67, low p-53, and high EGFR expression levels and oral cavity/oropharyngeal primary cancer sites tended to benefit from p-CAIR. A joint score for the gain in LRC from p-CAIR based of these features was used to separate the patients into two groups: those who benefited significantly from p-CAIR with respect to LRC (n = 49 patients; 5-year LRC of 28% vs. 68%; p = 0.01) and those who did not benefit from p-CAIR (n = 99 patients; 5-year LRC of 72% vs. 66%; p = 0.38). The nm23 expression level appeared useful as a prognostic factor but not as a predictor of fractionation effect.
These results support the studies that demonstrate the potential of molecular profiles to predict the benefit from accelerated radiotherapy. The molecular profile that favored accelerated treatment (low Ki-67, low p-53, and high EGFR expression) was in a good accordance with results provided by other investigators. Combining individual predictors in a joint score may improve their predictive potential.
根据一项针对头颈部鳞状细胞癌术后常规分割（p-CF）治疗与每周 7 天连续加速照射（p-CAIR）治疗的随机临床试验数据，确定分子标志物表达谱的预后和预测价值。
对 148 例患者（72 例 p-CF 患者和 76 例 p-CAIR 患者）的肿瘤样本进行了分子研究。免疫组织化学用于评估 EGFR、nm23、Ki-67、p-53 和细胞周期蛋白 D1 的表达水平。为了评估分割与表达谱的相对影响，使用 Cox 比例风险回归模型分析局部区域肿瘤控制（LRC）的数据。使用 Cox f 检验比较生存曲线。
Ki-67、p-53 和 EGFR 表达水平低、口腔/口咽原发性癌症部位的患者倾向于从 p-CAIR 中获益。基于这些特征，基于 p-CAIR 获得的 LRC 增益的联合评分用于将患者分为两组：从 LRC 角度显著受益于 p-CAIR 的患者（n = 49 例；5 年 LRC 为 28% vs. 68%；p = 0.01）和未从 p-CAIR 中获益的患者（n = 99 例；5 年 LRC 为 72% vs. 66%；p = 0.38）。nm23 表达水平似乎可用作预后因素，但不能用作分割效果的预测因素。
这些结果支持了表明分子谱有可能预测加速放疗获益的研究。有利于加速治疗的分子谱（Ki-67、p-53 和 EGFR 表达低）与其他研究人员提供的结果非常吻合。将个体预测因素结合在联合评分中可能会提高其预测潜力。
