Significance of Tumor Stage in Sinonasal Undifferentiated Carcinoma Survival

Objective

To describe the incidence and determinants of survival of patients with sinonasal undifferentiated carcinoma (SNUC) from 1973 to 2011 using the SEER database (Surveillance, Epidemiology, and End Results), with consideration of tumor stage based on the Kadish system.

Study Design

Retrospective database analysis.

Setting

Academic medical center.

Subjects and Methods

The SEER registry was utilized to calculate survival trends for 328 patients with SNUC between 1973 and 2011. Patient data were then analyzed with respect to histopathology, age, sex, race, subsite, modified Kadish stage, tumor size, and treatments rendered.

Results

The cohort was composed of 61.9% males with median age of 60 years. The median overall survival (OS) was 1.9 years. Most tumors presented in the nasal cavity, maxillary sinus, and ethmoid sinus (29.3%, 27.4%, 21%, respectively); 43.7% of patients received both surgical and radiation therapy. OS at 2, 5, and 10 years was 43%, 30%, and 25%, respectively. On univariate analysis, age, Kadish stage, and tumor size were associated with worse OS and disease-specific survival (DSS), while surgery and radiation therapy were associated with improved OS and DSS (all P < .05). On multivariate analysis, radiation therapy and lower Kadish stage were associated with improved OS and DSS, while younger age was additionally associated with improved OS (all P < .05).

Conclusion

SNUC is a rare but aggressive sinonasal malignancy. Tumor stage as determined by the Kadish system is associated with worse survival, with radiation therapy appearing to play a key role in therapeutic management.

Hypopharyngeal venous malformation presenting with foreign body sensation and dysphagia

OBJECTIVE

Review the importance of imaging selection and clinicoanatomic correlation for a vascular malformations presenting with unique symptomatology.

METHODS

Case study and literature review.

RESULTS

A 64-year-old female presented with globus and dysphagia ongoing for 40 years. Esophagogastroduodenoscopy discovered a hypopharyngeal mass. A CT scan showed a soft tissue mass with shotty calcifications. Flexible laryngoscopy revealed a bluish compressible mass. MRI showed T2 hyperintensity with heterogeneous enhancement resulting in the diagnosis of a low-flow vascular malformation.

CONCLUSIONS

All globus is not equal. Attention to symptoms, anatomy, and imaging selection is crucial for the diagnosis and treatment of vascular malformations uniquely presenting with dysphagia.

Laryngeal oncocytic cystadenomas masquerading as laryngoceles

OBJECTIVE

To describe an experience with laryngeal oncocytic cystadenomas and review the published literature regarding this uncommon diagnosis.

METHODS AND RESULTS

A clinical review of patients presenting with cystic laryngeal masses in an urban academic medical center between January and December 2013 was performed. Three patients, two female and one male, with a mean age of 68 years, were diagnosed with oncocytic cystadenomata of the larynx. Major presenting symptoms included dysphonia, globus, and ipsilateral otalgia. Endoscopic examinations revealed a cystic structure arising from varied subsites of the larynx: laryngeal ventricle, aryepiglottic fold, and pre-epiglottic space. Cross-sectional radiographic imaging was obtained in each case. The patients were treated with transoral (CO2) laser microsurgery (TLM). In all three cases, pathological analysis revealed oncocytic cystadenoma with clear margins.

CONCLUSIONS

Oncocytic cystadenoma is a rare entity of the larynx predominantly affecting elderly patients. Clinical presentation and imaging may suggest the diagnosis of an internal laryngocele. Complete excision is both diagnostic and therapeutic, and typically can be achieved using TLM. When clear margins are obtained, no adjuvant therapy is indicated. Although laryngoceles and malignancies are more commonly encountered, oncocytic cystadenomas should remain in the differential of cystic laryngeal masses.

Hyponatremia and perioperative complications in patients with head and neck squamous cell carcinoma

BACKGROUND

Recent studies suggest that hyponatremia is associated with perioperative morbidity and mortality after general surgical procedures, as well as mortality among medical inpatients. We investigated the association of hyponatremia with perioperative complications in patients undergoing surgical resection of head and neck squamous cell carcinoma (HNSCC).

METHODS

All patients with pathologically confirmed HNSCC undergoing either primary or salvage surgical resection from March 1, 2013, until May 31, 2014, at a single tertiary care academic center were included in this retrospective review. The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications (respiratory, cardiac, renal, and wound), hospital and intensive care unit (ICU) length of stay, and need for blood transfusion.

RESULTS

Two hundred fourteen surgical patients with HNSCC were identified for analysis. Patient ages ranged from 22 to 100 years (mean, 67 years). One hundred thirty-eight men and 76 women were included. Primary tumor sites were oral cavity (47.7%), oropharynx (18.7%), larynx (12.6%), salivary glands (7.9%), cutaneous (7.5%), sinonasal (2.8%), and hypopharynx (2.3%). Surgical resections were balanced between primary (48.1%) and salvage (51.9%). Thirty-five patients (16.4%) carried a presurgical diagnosis of diabetes. Fifteen patients (7.0%) demonstrated preoperative hyponatremia, and 46 (24.9%) had postoperative hyponatremia. Within the primary outcome measure, no difference in mortality was identified. Complications were noted in 58 patients (27.1%), and were more frequent in hyponatremic patients, both preoperatively and postoperatively (60.0% and 41.3%, respectively). Binomial logistic regression demonstrated risk of complications significantly associated with preoperative hyponatremia (odds ratio [OR] = 4.374; 95% confidence interval [CI] = 1.231-15.545; p = .023), increasing age (OR = 1.385; 95% CI = 1.032-1.857; p = .030), and increasing length of surgery (OR = 1.234; 95% CI = 1.046-1.455; p = .013). Postoperative hyponatremia was associated with increased hospital length of stay (p = .034).

CONCLUSION

Hyponatremia is a frequent electrolyte abnormality in patients with HNSCC. Both preoperative and postoperative hyponatremia are associated with perioperative morbidity, thus meriting intensive postoperative medical monitoring and treatment. Additional investigation is warranted to identify the pathophysiologic mechanisms behind this association. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1370-E1374, 2016.

John MA. Basaloid squamous cell carcinoma of the maxilla: Report of a case and literature review

PURPOSE

Basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma characterized by a highly aggressive clinical course. Though typically found in the larynx, oropharynx, and hypopharynx, we report a rare case of BSCC originating in the maxillary sinus in an otherwise healthy 32-year-old male.

MATERIALS AND METHODS

Single case report of a patient with BSCC of the maxillary sinus and retrospective chart review of all cases of BSCC of the maxilla at a single academic institution between January 1, 1986 and December 31, 2013. The MEDLINE database was additionally queried for all case series or reports of BSCC arising in the maxilla, and pertinent clinical data were extracted.

RESULTS

The clinical presentation, disease course, and management of a patient with BSCC of the maxilla are presented. In this recent case, the patient presented with persistent alveolar pain and a nonhealing tooth infection. Radiographic studies demonstrated a large necrotic mass in the left maxillary sinus that was biopsy-proven as BSCC. The patient underwent surgical resection followed by postoperative radiation without complications.

CONCLUSIONS

BSCC of the maxilla is a rare oncologic entity that may progress to late disease stage without obvious clinical signs or symptoms. Optimal treatment involves complete surgical resection followed by postoperative.

Epidemiology and treatment of lacrimal gland tumors: a population-based cohort analysis

IMPORTANCE

Primary tumors of the lacrimal gland are rare and are associated with substantial morbidity and mortality. The literature regarding these tumors is limited to case series and case reports.

OBJECTIVE

To examine the incidence, treatment, and overall survival (OS) and disease-specific survival (DSS) of patients with cancer of the lacrimal gland.

DESIGN, SETTING, AND PARTICIPANTS

Population-based cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with primary tumors of the lacrimal gland from 1973 to 2010.

MAIN OUTCOMES AND MEASURES

Overall survival and DSS.

RESULTS

A total of 321 patients with nonlymphoid tumors of the lacrimal gland were identified. The most common histological subtypes were adenoid cystic carcinoma (ACC) (32.1%) and squamous cell carcinoma (SCC) (29.9%). Survival analysis revealed a 5-year OS and DSS for all lacrimal gland tumors of 60% and 75%, respectively. On univariate analysis, low tumor grade (P = .04) and surgical treatment (P < .001) were associated with significantly better OS. For ACC tumors, surgery (P = .009), but not radiotherapy (P = .44), was found to significantly improve OS. For SCC tumors, surgical treatment significantly improved both OS (P < .001) and DSS (P = .004); radiation therapy also significantly improved OS (P = .03). Using a multivariable analysis model, age (hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]; P < .001), surgery (HR, 0.43 [95% CI, 0.25-0.75]; P = .003), and T stage at presentation (HR, 1.18 [95% CI, 1.01-1.37]; P = .03) were found to be independent predictors of OS. For ACC alone, age (HR, 1.04 [95% CI, 1.02-1.06]; P < .001) and surgery (HR, 0.35 [95% CI, 0.13-0.91]; P = .03) were independent predictors of OS. For SCC, age (HR, 1.05 [95% CI, 1.02-1.09]; P = .005), surgical resection (HR, 0.31 [95% CI, 0.12-0.83]; P = .02), and radiation therapy (HR, 0.33 [95% CI, 0.14-0.80]; P = .01) were independent predictors of OS.

CONCLUSIONS AND RELEVANCE

Our study demonstrates that ACC is the most common malignant epithelial neoplasm of the lacrimal gland. Determinants of survival for tumors of the lacrimal gland include age at diagnosis and surgical therapy. Radiation therapy is associated with improved DSS in SCC but not in ACC.

Carcinoma ex-pleomorphic adenoma of the parotid gland consisting of high-grade salivary duct carcinoma and keratinizing squamous cell carcinoma

Carcinoma ex-pleomorphic adenoma (CXPA) is a rare salivary gland malignancy that presents diagnostic difficulties partly because of its wide range of histologic presentations. We report a case of a 77-year-old man, who presented with a 6-year history of a parotid mass that had undergone rapid growth within weeks. Magnetic resonance imaging revealed an infiltrative mass in the parotid gland, and the fine-needle aspiration (FNA) biopsy result was highly suspicious for carcinoma. Subsequent excision of the tumor demonstrated a poorly differentiated epithelial neoplasm consisting of keratinizing squamous cell carcinoma (SCC) and adenocarcinoma with regions of both ductal carcinoma in situ and invasive salivary duct carcinoma (SDC). Only focal areas exhibited a benign pleomorphic adenoma component. To our knowledge, this is the first case of a CXPA that consists of both a high-grade SDC and a keratinizing SCC in the parotid gland.

MRI criteria for the diagnosis of pleomorphic adenoma: a validation study

OBJECTIVES

To validate an MRI algorithm characteristic of pleomorphic adenoma (PA).

STUDY DESIGN

Cross-sectional analysis.

SETTING

Academic tertiary-care medical center.

METHODS

A radiologic algorithm for the MRI diagnosis of PA was developed on the basis of five "high probability" criteria that all must be fulfilled for the MRI to qualify as a positive test result: bright T2-signal, sharp margins, heterogeneous nodular enhancement, lobulated contours, T2-dark rim. We then identified MRI images from our institutional database to test the diagnostic accuracy of the proposed algorithm.

RESULTS

A total of 103 parotidectomy cases with adequate MRI studies were identified (pleomorphic adenoma n=41, mucoepidermoid carcinoma n=11, Warthin's tumor n=8, adenoid cystic carcinoma n=6, oncocytoma n=6, acinic cell carcinoma n=5, salivary duct carcinoma n=5, and other n=21). Eighteen of 21 cases that met all five "high probability" MRI criteria were consistent with PA on final histopathology; 3 were consistent with carcinoma. MRI had a specificity of 95.1% [95% confidence interval: 85.6-98.7%] and sensitivity of 43.9% [95% C.I.: 28.8-60.1%] for PA. The positive predictive value was 85.7% [95% C.I.: 70.4-100%] and the negative predictive value was 71.9% [95% C. I.: 62.0-81.9%]. The overall diagnostic accuracy was 74.8% [95% C.I.: 66.2-83.3%].

CONCLUSION

A "high probability" MRI is about 95% specific for pleomorphic adenoma. A subset of patients with MRI imaging that is highly suggestive of PA may reliably avoid further workup. The value of MRI in this setting is especially useful if preoperative fine needle aspiration is not readily available. A significant proportion of PAs, however, have indeterminate imaging features that overlap considerably with other benign and malignant lesions.

Abstract 1141: p53-dependent regulation of epithelial-to-mescenchymal transition by nf-κb in head and neck squamous cell carcinoma

PURPOSE:

In head and neck squamous cell carcinoma (HNSCC), mutations of p53 usually coexist with aberrant activation of NF-kappaB (NF-κB) and other transcription factors which promote tumor pathogenesis. However, how these factors mediate oncogenesis and metastasis is not fully understood. Herein we investigate the mechanisms by which p53 and NF-κB contribute to Epithelial-Mesenchymal Transition (EMT) in HNSCC.

EXPERIMENTAL DESIGN:

We evaluated the effects of p65 mutation on the molecular events of EMT in surgical specimens and HNSCC cell lines. We examined the correlation with tumor histologic features.

RESULTS:

In HNSCC cell lines with mutant p53, p65 knockdown promotes EMT. In contrast, in normal oral epithelial cells or HNSCC cells with WT p53, p65 over-expression, instead of knockdown, promotes EMT. Ablation of p53 in normal oral epithelial cells blocks p65 induced EMT. These findings are functionally corroborated herein in three-dimensional cell culture, anchorage-independent growth assays, and tumor cell migration assays.

CONCLUSIONS:

This is the first report indicating the role of p53 status in the NF-κB -induced promotion of EMT in HNSCC. Bortezomib-based regimens have been shown to have minimal activity in recurrent or metastatic head and neck cancer. Our new findings are important in understanding a possible basis for these clinical findings as well as defining important implications for targeted chemoprevention and therapy.

Citation Format: Yuan Lin, Jie Luo, Elliot Abemayor, Sherven Sharma, Steven Dubinett, Maie St John. p53-dependent regulation of epithelial-to-mescenchymal transition by nf-κb in head and neck squamous cell carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1141. doi:10.1158/1538-7445.AM2014-1141

Esthesioneuroblastoma: an update on the UCLA experience, 2002-2013

Objectives To profile the clinical presentation and treatment results of esthesioneuroblastomas at the University of California, Los Angeles (UCLA), from 2002 to 2013. Design Retrospective review. Setting Tertiary academic institution. Participants Forty-one patients with esthesioneuroblastomas treated at UCLA. Main Outcome Measures Overall survival (OS) and recurrence-free survival (RFS). Results Thirty-six patients were included with a mean age of 50.1 years and a median duration of follow-up of 33 months. The 5-year RFS and OS were 54% and 82%, respectively. Modified Kadish stage was the only factor identified to affect OS. Multivariate analysis demonstrated that tumor grade was the only factor that had an independent impact on RFS. There was no statistical difference in survival among the surgical approaches chosen. Conclusions The updated data on the UCLA experience reveals that all three surgical approaches chosen provide comparable survival, although longer follow-up will be needed to ascertain if these findings hold true. The endoscopic approach had a statistically significant decrease in length of hospital stay and a trend toward reduced blood loss, intensive care unit admission, and complications. The modified Kadish staging was the only factor identified to predict OS. Multivariate analysis revealed that tumor grade was an independent predictor of recurrence; therefore, its importance should be emphasized in future staging systems.

Adenoid Cystic Carcinoma of the Lacrimal Gland: A Case Report with a Review of the Literature

Adenoid cystic carcinomas, the most common malignancies of the lacrimal gland, are rare overall. We describe a patient who presented with right periorbital swelling developing over 5 months and magnetic resonance imaging findings of a soft tissue mass in the lacrimal fossa with invasion of the adjacent bone. The patient underwent right lateral orbitotomy with tumor debulking. Pathologic analysis showed neoplastic cells in a predominantly cribriform pattern, and the patient was diagnosed with an adenoid cystic carcinoma of the lacrimal gland. We review the clinical, radiographic, and histopathologic features of these rare, aggressive malignancies as well as treatment options with reference to the current literature.

John M. Head and neck sarcomas: the UCLA experience

PURPOSE

To profile the clinical presentation, subtype distribution, and treatment results of sarcomas of the head and neck at a single tertiary academic center over an 11-year period.

MATERIALS AND METHODS

A retrospective review was performed by examining the records and reviewing the pathology of 186 patients with head and neck sarcomas treated at UCLA Medical Center from 2000 to 2011.

RESULTS

The mean age of the study population was 49 ± 22 years. 58% of the patients were male and 42% were female. Median duration of follow-up for the entire group was 18.5 months. The most common presenting symptom was a mass lesion in 59.9% of patients. The nasal cavity/sinus was the most common presenting site seen in 22% of patients. Solitary fibrous tumor/hemangiopericytoma was the most common subtype. 15% of patients had evidence of prior radiation exposure. 26.3% of tumors were greater than 5 cm and 35.5% were high-grade. Margins were positive in 31.2% of patients. Lymph node metastasis was rare at 6.5%. Perineural invasion was identified in 6.5%. Among all subtypes, 5-year recurrence-free survival and overall survival were 50% and 49%, respectively. Multivariate analysis demonstrated that grade and margin status were predictors of recurrence-free survival while grade and age affected overall survival.

CONCLUSIONS

Head and neck sarcomas are a rare entity frequently presenting as a mass lesion. In our series, lesions tended to be high-grade with a significant portion of surgical specimens having positive margins. Grade and margin status were the most important predictors of survival.

The emerging landscape of salivary diagnostics

Saliva as a diagnostic tool provides a noninvasive, simple and low-cost method for disease detection and screening. Saliva collection is more practical and comfortable compared with other invasive methods, and saliva can be a desirable body fluid for biomarker detection in clinical applications. The integration of omics methods has allowed accurate detection and quantification of transcripts found in saliva and a group of biomarkers has been discovered and validated in a series of studies. Here we review recent developments in salivary diagnostics that have been accomplished using salivaomics, the mechanisms of saliva diagnostics, as well as the translational and clinical application of saliva biomarkers.

Solitary fibrous tumor of the larynx: case report demonstrating the value of MRI in guiding surgical management

A 74-year-old woman presented with persistent dysphagia, dysphonia, and throat gurgling. Prior intraoperative biopsies were negative, and outside imaging revealed supraglottic swelling. Magnetic resonance imaging (MRI) demonstrated a well-defined T1 and T2 hypointense, avidly enhancing hypopharyngeal mass. Deep intraoperative rebiopsies revealed a tumor with CD34+ tissue, diagnostic of a solitary fibrous tumor. A broad range of nonsquamous cell tumors should be considered when a submucosal laryngeal mass is encountered. MRI may be particularly helpful in guiding appropriate biopsy.

John M. Are We Following Treatment Guidelines for Papillary Thyroid Carcinoma? Cost Implications: A SEER-Medicare Study

Objectives:

The National Comprehensive Cancer Network (NCCN) guidelines are evidence-based management algorithms for papillary thyroid carcinoma (PTC). We sought to determine whether actual practice patterns coincide with these guidelines and whether management outside NCCN guidelines affected Medicare costs.

Methods:

Surveillance, Epidemiology, and End Results (SEER) Medicare linked data were examined to determine treatment patterns for 4,582 patients with PTC from 1988-2007 that met our inclusion criteria. Indications for lobectomy, total thyroidectomy, and postoperative radioactive iodine ablation (RAI) were based on NCCN guidelines, including tumor size, extrathyroidal extension, positive lymph nodes, and aggressive histology. The cost related to PTC treatments was Medicare payments linked directly to each treatment’s claim code.

Results:

Seventy-six percent underwent total thyroidectomy, and 34% underwent thyroid lobectomy. According to NCCN guidelines, 90% received appropriate surgical management. Of patients with aggressive features based on NCCN guidelines, 33.4% should have received RAI. Based on intermediate tumor size, positive lymph nodes, and aggressive histology, 37.7% would have benefited from RAI. Of patients with tumors less than 1 cm and no ETE, 42% should not have received postoperative RAI. Patients undergoing thyroid lobectomy cost Medicare $50,175, while total thyroidectomy cost $54,455 ( P = 0.293). Postoperative RAI cost Medicare approximately $47,652 yearly.

Conclusions:

Ninety percent of patients received appropriate surgical management. However, 40% of patients did not receive appropriate postoperative RAI management. As the incidence of PTC rises, the use of evidence-based guidelines can reduce cost attributed to Medicare.

A Novel Modular Polymer Platform for the Treatment of Head and Neck Squamous Cell Cancer

Objectives:

Evaluate the therapeutic efficacy of a novel modular polymer platform in the treatment of head and neck squamous cell carcinoma (HNSCC). 50% of HNSCC patients fail primary management, and salvage of the recurrent disease patient is of paramount importance.

Methods:

Study Design: In vivo study. Setting: Academic research laboratory. C3H/HeJ mice were randomized to receive implantation of 1) no polymer; 2) plain polymer; 3) plain polymer containing gene-modified dendritic cells over-expressing CCL21 (DC-AdCCL21); and 4) plain polymer with concurrent daily CCL21 injections. Tumor size was measured until the mice were euthanized. At necropsy, the tumors were excised and weighed.

Results:

Our results using this novel polymer platform demonstrate a remarkable reduction in tumor growth. The dendritic cell CCL21 secreting polymer effectively reduced SCCVII/SF tumors in the C3H/HeJ mice by over 16-fold ( P < 0.01) as compared to control, plain polymer, and plain polymer + intratumoral CCL21 injection groups. We also demonstrate that we can effectively grow dendritic cells in the polymer that can actively secrete CCL21. Treatment with the dendritic cell CCL21 secreting polymer led to a marked reduction in tumor burden with extensive mononuclear cell infiltration of the tumors.

Conclusions:

Our promising results indicate that this polymer may represent a new therapeutic modality for patients with HNSCC. Our data provide a strong rationale for further evaluation of this DC-AdCCL21 polymer in regulation of tumor immunity and genetic immunotherapy for HNSCC. Once this polymer platform is further optimized, we will plan for the ultimate validation in the context of a prospective trial in patients with unresectable advanced or recurrent HNSCC.

John MA. Abstract 1490: p38 MAPK mediates epithelial-mesenchymal transition by regulating p38IP and snail in head and neck squamous cell carcinoma (HNSCC)

Objectives:

Understanding the molecular mechanisms that mediate HNSCC metastasis may enable identification of novel therapeutic targets. We have reported the role of the E-cadherin transcriptional repressor, Snail, in the inflammation-induced promotion of EMT in HNSCC. Herein we demonstrate that inflammatory mediators also upregulate p38 and p38 interacting protein (p38IP), thus further defining the cycle by which inflammation promotes tumor progression.

Methods:

A molecular biology study. Real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), Western blot analysis, and 3-D spheroid culture were used to determine how inflammation affects p38, p38IP and EMT.

Results:

p38 kinase inhibitor treated, and p38 shRNA HNSCC cell lines demonstrated a significant upregulation in E-cadherin mRNA and a decrease in the mRNA expression of the transcriptional repressor Snail. p38 shRNA HNSCC cell lines show a less invasive phenotype in a spheroid model, and demonstrate decreased tumor growth in a SCID mouse model. An inverse relationship between p-p38 and E-cadherin was demonstrated in situ by immunohistochemical staining of human HNSCC tissue sections. Activation of p38 is required for the robust IL-1β induced E-cadherin downregulation and Snail upregulation. IL-1β increases p-p38 and has a more rapid and robust effect on p38. Snail overexpression also enhanced p-p38 in vitro. Inhibition of p38 blocked HNSCC tumor growth in vivo. p38 activates p38IP, a p38 downstream component in STAGA transcriptional activator complex, in HNSCC cell lines. p38 bound to and stabilized p38IP, a subunit of histone acetyltransferase STAGA, resulting in enhanced transcription of Snail. Inhibition of p38IP blocked HNSCC migration and invasion both in vitro and in vivo. In HNSCC patient samples, p38IP expression was increased compared to adjacent normal tissue.

Conclusions:

In gastrulation, a Snail-independent P38/P38IP pathway is required in the primitive streak to downregulate E-cadherin expression at the posttranscriptional level. Herein we provide the first report that in HNSCC a snail-dependent p38/p38IP pathway is essential for E-cadherin down-regulation and cell invasion. Our work herein demonstrates for the first time that a snail-p38/p38IP feedback loop jointly down regulates E-cadherin and drives a potent EMT in HNSCC. This newly defined pathway has important implications for targeted chemoprevention and therapy.

Citation Format: Yuan Lin, Guangyu Wang, Jie Luo, Chi Lai, Elliot Abemayor, David Elashoff, Steve Dubinett, Maie A. St. John. p38 MAPK mediates epithelial-mesenchymal transition by regulating p38IP and snail in head and neck squamous cell carcinoma (HNSCC). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1490. doi:10.1158/1538-7445.AM2013-1490