Prognostic significance of mitotic and apoptotic index and the DNA cytometry in head and neck cancer
Abstract:
The lack of suitable criteria to predict the response to chemo- and or radiotherapy for individual patients with squamous cell carcinoma of the head and neck (HNSCC) remains still a major problem. This study was conducted to analyze prognostic significance of mitotic and apoptotic index and the DNA flow cytometric analysis of HNSCC to the recurrence-free survival time and to the overall survival. The analysis was carried out in a set of 56 patients suffering from carcinoma of the pharynx and supraglottis. Most patients (96.7%) underwent neoadjuvant chemotherapy, followed by surgery and postoperative irradiation. Besides routine examinations, flow cytometric analysis was performed, as well as p53 and Ki-67 markers and mitotic and apoptotic index were established by means of immunohistochemistry. Event-free survival (EFS) and overall survival (OS) were accepted as primary endpoints for the prognostic analyses. All the examined potential markers entered standard Kaplan-Meier survival analysis and Cox regression modeling. Statistical significance of prognostic factors was first examined in univariate models and all the parameters subsequently entered multivariate models. The analyses revealed significant prognostic position of advanced clinical stage (III+IV) and increased proliferative activity as primary risk factors (p