MOLECULAR ASSESSMENT OF HISTOPATHOLOGICAL STAGING IN SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK
MOLECULAR ASSESSMENT OF HISTOPATHOLOGICAL STAGING IN SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK
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DOI：
10.1056/nejm199502163320704
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发表时间：
1995-02-16
影响因子：
158.5
通讯作者：
SIDRANSKY, D
中科院分区：
文献类型：
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作者：
BRENNAN, JA;MAO, L;SIDRANSKY, D
背景资料。外科肿瘤学家在很大程度上依赖于手术切缘的组织病理学评估，以确保头颈部癌症患者的肿瘤完全切除。然而，目前的技术可能无法在切除边缘或颈部淋巴结中检测到少量癌细胞。我们使用分子技术来确定在组织病理学阴性的头颈部鳞状细胞癌患者的手术切缘和颈部淋巴结中是否可以检测到携带p53基因突变的浸润性肿瘤细胞克隆群。我们确定了25例含有P53突变的头颈部原发鳞状细胞癌患者，在组织病理学评估为阴性的基础上，这些患者似乎已经接受了完全的肿瘤切除。在这25名患者中，有13名患者的分子分析至少有一个肿瘤边缘的p53突变呈阳性。在切缘阳性的13例患者中，有5例(38%)癌局部复发，而切缘阴性的12例患者中无一例复发(经对数等级检验，P=0.02)。此外，分子分析在组织病理学评估最初为阴性的28个淋巴结中发现了6个肿瘤细胞(21%)。在最初被认为是光学显微镜阴性的标本中，头颈部鳞状细胞癌患者的手术切缘和淋巴结中有相当大比例含有原发肿瘤特有的p53突变。切缘呈阳性的患者局部复发的风险似乎显著增加。手术切缘和淋巴结的分子分析可以加强标准的组织病理学评估，并可能改善对局部肿瘤复发的预测。
Background. Surgical oncologists rely heavily on the histopathological assessment of surgical margins to ensure total excision of the tumor in patients with head and neck cancer. However, current techniques may not detect small numbers of cancer cells at the margins of resection or in cervical lymph nodes.Methods. We used molecular techniques to determine whether clonal populations of infiltrating tumor cells harboring mutations of the p53 gene could be detected in histopathologically negative surgical margins and cervical lymph nodes of patients with squamous-cell carcinoma of the head and neck.Results. We identified 25 patients with primary squamous-cell carcinoma of the head and neck containing a p53 mutation who appeared to have had complete tumor resection on the basis of a negative histopathological assessment. In 13 of these 25 patients, molecular analysis was positive for a p53 mutation in at least one tumor margin. In 5 of 13 patients with positive margins by this method (38 percent), the carcinoma has recurred locally, as compared with none of 12 patients with negative margins (P=0.02 by the log-rank test). Furthermore, molecular analysis identified neoplastic cells in 6 of 28 lymph nodes (21 percent) that were initially negative by histopathological assessment.Conclusions. Among specimens initially believed to be negative on light microscopy, a substantial percentage of the surgical margins and lymph nodes from patients with squamous-cell carcinoma of the head and neck contained p53 mutations specific for the primary tumor. Patients with these positive margins appear to have a substantially increased risk of local recurrence. Molecular analysis of surgical margins and lymph nodes can augment standard histopathological assessment and may improve the prediction of local tumor recurrence.