New prognostic factors in nasopharyngeal carcinoma: Tumor angiogenesis and C-erbB2 expression

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Abstract
BACKGROUND This study was conducted to determine the prognostic significance of tumor angiogenesis, c‐erbB2, epidermal growth factor receptor, Ki‐67, and p53 for patients with nasopharyngeal carcinoma. METHODS In this retrospective study, the authors retrieved clinical data and made immunohistochemical preparations on archival tissue specimens from 30 patients with nasopharyngeal carcinoma treated with radiation therapy at the University of California at San Francisco between 1956 and 1990. The pretreatment clinical and immunohistochemical data were correlated with cervical lymph node metastasis at diagnosis, and endpoints including development of locoregional failure, distant metastasis, disease free survival, and overall survival. RESULTS Intense tumor angiogenesis, defined as microvessel counts of 60 or more microvessels per 200× field correlated with the development of distant metastasis (P = 0.03), shorter overall survival (P = 0.02), and disease free survival (P = 0.05). Strong c‐erbB2 expression correlated with a shorter overall survival (P = 0.02) and disease free survival (P = 0.02). Stage IV disease (P = 0.04) and the presence of cervical lymph node metastasis (P = 0.05) correlated with a shorter overall survival. A duration of symptoms of fewer than 6 months correlated with a shorter disease free survival (P = 0.05). No association was observed between any of the biologic prognostic factors and lymph node involvement or locoregional failure. CONCLUSIONS The results of this study show that tumor angiogenesis and c‐erbB2 expression are significant prognostic indicators for patients with nasopharyngeal carcinoma. The presence of cervical lymph node metastasis, Stage IV disease, and a duration of symptoms of fewer than 6 months also indicate a poor prognosis. The authors did not find any prognostic significance for epidermal growth factor receptor, Ki‐67, or p53. These results suggest that tumor microvessel counts and c‐erbB2 may be useful in identifying patients who may benefit from systemic chemotherapy or other novel treatment strategies. Cancer 1996; 77:1419‐26.