Franchi A, Gallo O, Boddi V, Santucci M
Institute of Anatomic Pathology, Otolaryngology Clinic, and Institute of General Pathology, University of Florence, Viale G. B. Morgagni 85, 50134 Florence, Italy.
Clin Cancer Res. 1996 Oct;2(10):1801-8.
The aim of this study is to investigate the predictive value of proliferative activity assessment and E-cadherin expression by means of immunohistochemistry in identifying patients with laryngeal squamous cell carcinoma at a high risk for occult node metastasis. Thirty consecutive patients treated for laryngeal carcinoma with false clinically negative nodes (occult metastases, pN+) between the years 1980 and 1990 were selected for this study. A group of 30 cases with negative cervical lymph nodes (pN-) having a similar anatomic site and tumor size distribution was used as control. In each case, several histological parameters, including grade, pattern of invasion, number of mitosis (x10 high-power field), tumor inflammatory infiltrate, and tumor sclerosis, were assessed. Proliferative activity was determined using immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and MIB-1. Other putative prognostic factors investigated at the immunohistochemical level were the cell adhesion molecule E-cadherin and two oncoproteins, p53 and c-erbB-2. In pN+ cases, the expression of PCNA and MIB-1 was significantly higher than in the pN- group. Moreover, a significant loss of E-cadherin expression was observed in carcinomas with occult metastases. No differences in p53 and c-erbB-2 oncoproteins were found between pN+ and pN- cases. Among the other pathological parameters examined, only histological grade was significantly associated with the presence of occult metastases, but on multivariate analysis, this relationship was lost. We conclude that PCNA, MIB-1, and E-cadherin are independent predictors of occult nodal disease in laryngeal squamous cell carcinoma, and their immunohistochemical determination could be useful in identifying patients with clinically negative lymph nodes who are at considerable risk for occult metastases and who may benefit from elective neck dissection.
本研究的目的是通过免疫组织化学方法，研究增殖活性评估和E-钙黏蛋白表达在识别喉鳞状细胞癌隐匿性淋巴结转移高危患者中的预测价值。本研究选取了1980年至1990年间连续30例接受喉癌治疗且临床淋巴结假阴性（隐匿性转移，pN+）的患者。选取30例颈部淋巴结阴性（pN-）且解剖部位和肿瘤大小分布相似的病例作为对照。对每例患者评估多个组织学参数，包括分级、浸润模式、有丝分裂数（×10高倍视野）、肿瘤炎症浸润和肿瘤硬化。使用增殖细胞核抗原（PCNA）和MIB-1的免疫组织化学染色来确定增殖活性。在免疫组织化学水平上研究的其他假定预后因素是细胞黏附分子E-钙黏蛋白以及两种癌蛋白p53和c-erbB-2。在pN+病例中，PCNA和MIB-1的表达明显高于pN-组。此外，在隐匿性转移癌中观察到E-钙黏蛋白表达显著缺失。在pN+和pN-病例之间未发现p53和c-erbB-2癌蛋白有差异。在所检查的其他病理参数中，只有组织学分级与隐匿性转移的存在显著相关，但在多变量分析中，这种关系消失了。我们得出结论，PCNA、MIB-1和E-钙黏蛋白是喉鳞状细胞癌隐匿性淋巴结疾病的独立预测指标，其免疫组织化学测定有助于识别临床淋巴结阴性但隐匿性转移风险较高且可能从选择性颈清扫术中获益的患者。
