Cancer stem cell biomarkers in locally advanced head and neck squamous cell carcinoma.

OBJECTIVES

To analyze the presence of cancer stem cells markers in consecutive patients with locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) and establish their suitability as a prognostic biomarker in samples from routine practice.

METHODS

Retrospective study of 104 consecutive patients with locally advanced HNSCC treated with definitive surgery and adjuvant chemoradiotherapy. Immunohistochemical expression of CD44, HLA-I, pan-cytokeratin, and phosphorylated Epidermal Growth Factor Receptor (p-EGFR) were evaluated in surgical specimens. Overall Survival (OS) and Disease-Free Survival (DFS) rates were calculated based on clinical characteristics and the total positive score (for tumor marker expression). Hazard ratios were calculated by Cox multivariate analysis.

RESULTS

After a median follow-up of 50-months, higher OS rates were observed for patients without cervical node pathological involvement (p < 0.001), patients with HLA-I overexpression and a total positive score ≥ 15% (p = 0.017), and patients with low CD44 expression and a total positive score ≤ 60% (p = 0.022). Grouping by p-EGFR (p = 0.648) or pan-cytokeratin (p = 0.477) expression did not show statistical differences in OS. None of the biomarkers were associated with different DFS rates. Cox multivariate analysis revealed that positive cervical nodes (HR = 1.294; 95% CI 1.025-1.634; p = 0.030) and the expressions of HLA (HR = 0.373; 95% CI 0.168‒0.829; p = 0.015) and CD44 (HR = 2.170; 95% CI 1.031-4.569; p = 0.041) were independently associated with OS.

CONCLUSION

Nodal involvement, HLA-I overexpression, and decreased CD44 expression are independent prognostic factors of survival in patients with locally advanced HNSCC.

LEVEL OF EVIDENCE

III.