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Tumor Angiogenesis as a Predictive Marker for Organ Preservation in Patients With Advanced Laryngeal Carcinoma
Author(s) -
Teknos Theodoros N.,
Cox Claudell,
Barrios Martin A.,
Chepeha Douglas B.,
Bradford Carol R.,
Fisher Susan G.,
Wolf Gregory T.
Publication year - 2002
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200205000-00013
Subject(s) - medicine , laryngectomy , larynx , chemotherapy , stage (stratigraphy) , cancer , carcinoma , angiogenesis , population , biopsy , oncology , surgery , urology , pathology , paleontology , environmental health , biology
Background The purpose of this study was to retrospectively investigate tumor angiogenesis as a predictive marker for response to neoadjuvant chemotherapy, organ preservation, and survival in patients with advanced laryngeal carcinoma. Methods A total of 332 patients with stage III (188 patients) or stage IV (144 patients) squamous cell carcinoma of the larynx were entered in the prospective trial conducted by the Department of Veteran Affairs Laryngeal Cancer Study Group. Of this patient population, 20 pretreatment biopsy specimens were available from the chemotherapy arm for immunohistochemical analysis of Factor VIII expression. Two blinded investigators determined microvessel density in each patient by manual inspection of 10 high‐power (400×) fields (HPF). Results The patients who had a partial response (>50% decrease in tumor volume) or complete response to chemotherapy had a mean value of 20.90 (± 8.09 standard deviation [SD]) blood vessels per HPF. Those who did not respond to chemotherapy and thus required a total laryngectomy had a mean value of 32.99 (± 10.10 SD) vessels per HPF. The difference of the means was statistically significant using a two‐tailed t test ( P <.0085). Kaplan‐Meier survival curve analysis also revealed that patients with vessel counts above the mean tended to have poorer survival than those below the mean regardless of treatment selection. The most‐vascular tumors, those greater than 1 SD above the mean, had a statistically significant difference in survival and laryngeal preservation ( P = .0345). Conclusions These results indicate that tumor angiogenesis, as measured by number of vessels per HPF, was associated with decreased responsiveness to chemotherapy and radiation for larynx preservation. The most‐vascular tumors also were associated with poorer survival than those with lesser degrees of angiogenesis.