Carcinoma of the pyriform sinus: predictors of TNM relapse and survival

Prognostic value of p27Kip1 expression in Basaloid Squamous Cell Carcinoma of the larynx

Background

Very few reports have investigated the role of cell cycle regulators as biomarkers in Basaloid Squamous Cell Carcinoma (BSCC) of the larynx, a definite morphologic, uncommon, very aggressive variant of squamous cell carcinoma. Lower expression of Ki67/Mib-1, a proliferation marker highly expressed in the majority of tumours, and p53, a tumour suppressor protein that can induce an arrest of the G1-S transition, was related to a better prognosis in laryngeal BSCC. In the head and neck, p27^kip1, a member of the Cip1/Kip1 family of cyclin-dependent kinase inhibitors, has emerged as an independent prognostic factor, able to identify low-expressing tumours with unfavourable course. Up to date the role of this protein was never studied in BSCC. Aim of our study was to investigate the potential prognostic value of p27^kip1 levels and their correlation with Ki67/Mib-1 and p53 expression in BSCC of the larynx.

Methods

The retrospective study group consisted of 15 male and 1 female patients, affected by laryngeal BSCC, ranging in age from 44 to 69 years (mean 58). The tumour originated from the supraglottis in thirtheen cases and from the glottis in the remaining three. Ten patients had metastatic cervical lymph nodes at presentation and were classified as N+. Post surgical stage was IV in four patients, III in nine, II in two cases and I in the remaining one. Follow-up ranged from a minimum of 5 months up to 9 years. Paraffin-embedded tissue sections of each laryngeal tumour were analyzed for p27^kip, Ki67/Mib-1 and p53 expression by immunohistochemistry.

Results

The immunohistochemical study showed p27^kip1 expression in 40% of the patients with no evidence of disease (NED) and in none (0%) of the patients dead of disease (DOD), whilst p53 was expressed in 60% of patients in NED status and in 90% of patients in DOD status. Ki67/Mib-1 was positive in 80% of NED patients and in 100% of DOD patients. At multivariate analysis, performed by means of Discriminant analysis, low levels of p27^kip1 expression significantly correlated with poor prognosis (P < 0.05).

Conclusion

p27^kip1 protein has been shown to be a significant independent prognostic factor in laryngeal SCC. In our series of laryngeal BSCC the resulting data seem to confirm the clinical prognostic relevance of p27^kip1 low expression, which directly correlated with biological aggressiveness and consequent shortened survival.

Prognostic indicators for survival in head and neck squamous cell carcinomas: analysis of a series of 621 cases

BACKGROUND

We sought to study the influence of pT classification, pN status, tumor volume, and number of lymph nodes invaded on survival of patients with head and neck cancers to improve therapeutic indications.

METHODS

This was a retrospective study of 621 consecutive patients treated from 1990 to 1997 by a single team.

RESULTS

In univariate analysis, pT classification (p < .0001), pN status (p < .0001), capsule rupture (p < .0001), the number of lymph nodes invaded (0, 1-3, 4-9, > or =10) (p < .0001), and the tumor volume (p < .0001) were significantly associated with overall survival. A Cox model identified as independent prognostic indicators age (p < .0001), pT classification (p < .0001), and pN status (p < .0001).

CONCLUSIONS

Not only pT classification and pN status but also the number of the lymph nodes invaded and the tumor volume should be considered as essential prognostic indicators, and any clinical trial developed should stratify accordingly.

A Review of Prognostic Pathologic Features and Algorithms for Patients Treated Surgically for Renal Cell Carcinoma

Accurate subtyping of RCC is critically important and should be considered in algorithms that are developed as prognostic tools for the patient and clinician. The TNM classification, already a powerful prognostic factor, will continue to evolve. The authors recommend that each component of the classification be assessed and reported during pathologic examination. This article also highlighted the importance of assigning a nuclear grade that is based on standardized and reproducible criteria that reflect the heterogeneity of nuclear and nucleolar features within RCC. Lastly, it is increasingly evident that coagulative tumor necrosis and sarcomatoid differentiation are compelling prognostic factors, on par with nuclear grade, and should be assessed routinely. To conclude, the complete list of pathologic features that are evaluated as part of the Mayo Clinic Nephrectomy Registry is presented. The features that are reported routinely in clinical practice also are indicated; this can serve as a guide for the reporting of results from the pathologic examination of RCC.

[Hypopharyngeal cancer: analysis of the evolution and surgical results]

OBJECTIVE

Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer.

METHODS

We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation.

RESULTS

The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%.

CONCLUSIONS

Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

[Distant metastases in patients with advance laryngeal carcinoma]

Patients with advanced stage cancer larynx have a higher risk of development of distant metastases which means a bad prognosis. In our study we try to identify risk factors with the idea of involve to all of these patients in more aggressive systemic therapy protocols. Data of 57 patients surgically treated, with squamous pharyngolaryngeal carcinoma, stage III and IV, are evaluated. Advanced T stage or more extensive neck disease more often caused distant metastases (p < 0.05), and also the histological evidence of tumor invasion in three or more cervical nodes (p = 0.02), and poorly differentiated tumors (p < 0.05). Tumor site, surface area in cm, presence of ulceration, and loco-regional uncontrol were not associated with distant metastases.

Squamous cell carcinoma of the pyriform sinus: a nonrandomized comparison of therapeutic modalities and long-term results

From January 1964 through December 1991, 408 patients with squamous cell carcinomas involving the pyriform sinus were treated at Washington University Medical Center. Their ages ranged from 29 to 83 years (mean, 62.3; median 59) and the male to female ratio was 5:1. The mean duration of symptoms prior to diagnosis was 3.9 months (range 1 to 32 months) and 89% had a smoking or ethanol history. Sixty-seven percent had T3 or T4 lesions and 87% were stage III or IV at presentation. Sixty-nine percent had neck metastases. The treatment strategy varied with respect to radiation and reconstruction. Prior to 1978, preoperative radiation (3.5 to 5000 cGy) was used. Postoperative radiation was given thereafter (600+ Gy). Since 1982, flap reconstruction (usually pectoralis major myocutaneous) has been used to close the partial laryngopharyngectomy (PLP) defect. Almost all N0 necks were treated by radiation or surgery and all N1-N3 lesions were treated by combined therapy. Pyriform tumors were subdivided into three groups: 1. one-wall lesions (n = 48), 2. medial-wall lesions which involved the aryepiglottic fold or supraglottis (N = 267), and 3. two- or three-wall lesions which extended to the pyriform apex or post-cricoid region (N = 93). Ninety-five patients had single-modality therapy and 302 had combined treatment. Two hundred seven patients had conservation surgery (PLP) and 157 had total laryngopharyngectomy alone or in combination with radiation. Thirty-three patients were treated by radiation alone. Eleven patients were excluded from the study because of distant metastases (TxNxM1) at presentation. The cumulative survival (NED) at 5, 10, 15, and 20 years was 56%, 35%, 31%, and 20%, respectively. The cumulative locoregional control rate was 71%. At 5 years (NED), the cure rates for one-wall lesions (73%) were better than for medial-wall lesions (63%) or 2- and 3-wall lesions (49%). One-wall lesions were smaller, medial-wall lesions behaved similar to supraglottic tumors, and two- or three-wall tumors behaved as hypopharyngeal tumors. The cure rates were related to T stage with T1 + T2 > T3 + T4 (28%). Neck metastases reduced the cure rate by 26% and N1 > N2-N3 by an additional 12%. Other factors contributing to therapeutic failure were distant metastases (17.7%), second primary tumors (6.2%; oropharynx and lung were most common), and intercurrent disease fatalities (9.5%). The secondary therapeutic salvage rate was 44% for surgery and 32% for radiation therapy. The therapeutic complication rate was 19% with 3.6% leading to fatality.(ABSTRACT TRUNCATED AT 400 WORDS)

Tumor vascularization, mitotic index, histopathologic grade, and DNA ploidy in the assessment of 114 head and neck squamous cell carcinomas

BACKGROUND

Quantification of tumor vascularization recently has been shown to a parameter of potential clinical significance. Several basic and clinical studies have demonstrated that tumor growth correlates significantly with angiogenesis.

METHODS

To determine the utility of quantification of tumor vascularization and mitotic index for the pathobiologic assessment of head and neck squamous cell carcinoma, a prospective study of 114 consecutively recruited primary neoplasms was performed. Tumors were also studied for differentiation, keratinization, nuclear atypia, growth pattern, inflammation, desmoplasia, vascular tumor emboli, and DNA content.

RESULTS

In this cohort, tumor vascularization was correlated with mitotic index (P < 0.001), nuclear grade (P = 0.03), presence of tumor emboli in the peripheral microvessels (P = 0.05), and lymph nodal status (P = 0.03). A strong relationship between poor differentiation and high N classification (P < 0.001), differentiation and keratinization (P < 0.001) and tumor cell emboli and clinically involved lymph nodes (P = 0.01) was also observed. Emboli were more rare in laryngeal and oropharynx/oral cavity tumors than in hypopharynx/epilarynx (P = 0.02).

CONCLUSIONS

This study indicates that tumor vascularization, differentiation, and tumor emboli in peripheral microvessel network are important histologic parameters in the assessment of squamous cell carcinoma of the head and neck.

Computer-aided individual prognoses of squamous cell carcinomas of the lips, oral cavity and oropharynx

Computer-aided individual prognoses (CIP) is a software-package developed on the basis of an empirical study and can be installed on any IBM-compatible personal computer. The project which went into the making of CIP was called "Prospective DOSAK-study on squamous cell carcinomas of the lips, oral cavity and oropharynx". In the course of the study 1485 patients were treated between 1977 and 1982, and followed up through 1985. CIP facilitates individual prognoses and comparisons of independent patient groups with parallel groups from the data of the above-mentioned study. In practical clinical work individual prognoses allow exact and reliable judgements on individual patients. In clinical cancer research it provides the information about prognostic factors required for controlled clinical studies. The comparison of independent patient populations allows for an ongoing qualitative control of the patients in each clinical institution. In clinical cancer research such a comparison means that certain characteristics of the patient, the tumor and of the disease can be given higher prognostic value. The same is true of the clinical testing of therapeutic measures which is typically carried out during phase-II-studies. Due to its menu-based organization CIP does not presuppose any specialist knowledge on the part of its users and can be regarded as particularly user-friendly.

Characterization, quantification, and potential clinical value of the epidermal growth factor receptor in head and neck squamous cell carcinomas

Epidermal growth factor (EGF) stimulates the growth of several types of epithelial tissues and possesses a strong mitogenic activity that is mediated through its cell surface receptor (EGFR). The aim of this study was to characterize EGFR and measure its levels in head and neck tumors biopsies (70 patients); use of a simplified competition technique with a radiolabeled ligand allowed evaluation of functional EGFR. Five samples (4 tumors and 1 control) were used to characterize EGF binding. Graphic representation identified a single family of binding sites. Kd values revealed high affinity for EGF binding: mean Kd, 0.156 +/- 0.108 nM (0.095-0.347 nM). EGF-binding characteristics (Kd) were similar in nontumoral tissue samples (controls) and in tumor material. In 59 of 60 cases, EGFR levels were higher in the tumor than in the corresponding controls. A significant correlation was found between EGFR levels and tumor size and stage. Controls exhibited a trend toward higher EGFR levels in elevated sizes and stages. According to a cutoff EGFR value of 100 fmol/mg protein, which separated all controls from tumors, EGFR-positive tumors (greater than 100 fmol/mg protein) had a greater probability of complete response to chemotherapy than EGFR-negative tumors; other tumor characteristics, such as the degree of tumoral differentiation, tumor size, or stage, were unable to operate such a discrimination in the response to chemotherapy. EGFR may thus be an interesting biological marker for head and neck cancer.

Poorly differentiated naso- and oropharyngeal carcinoma. A retrospective comparison between the results of radiotherapy alone and radiotherapy plus adjuvant methotrexate

One hundred and forty-one patients with poorly differentiated naso- and oropharyngeal carcinoma were treated at the Center of Oncology in Kraków 1970-1985. Ninety-eight patients, treated from 1970 to 1980, received radiation therapy alone and forty-three patients, treated from 1981 to 1985, received adjuvant monochemotherapy with methotrexate 60 mg/m2 i.v. administered every 6 weeks, starting 6 weeks after completion of radiotherapy. The two groups were comparable in patients' characteristics such as stage of the disease, sex, age, localization and histology. The three-year survival rate in the total group of 141 patients was 46.8%. Important prognostic factors were: stage (UICC 1987), extent of local tumour and nodal involvement. Three-year survival rates according to stage were as follows: stage I, 100%; stage II, 95%; stage III, 75% stage IV, 4.4%. There was no significant survival difference between the two groups, and the adjuvant methotrexate therapy did not alter the pattern of failures. The results do not support the hypothesis that adjuvant methotrexate treatment is beneficial in this type of patient.

Serum tumor markers of head and neck cancer: current status

The serum level of a variety of substances shows significant changes in head and neck cancer patients. Such substances are collectively called biochemical tumor markers. To date, most markers lack a high degree of specificity and sensitivity. However, serial measurement of markers showing elevated pretreatment levels may help in monitoring response to therapy. Other potential uses of tumor markers include earlier detection of recurrence and/or metastasis, and possible prediction of prognosis. Measurement of more than one marker seems to enhance the diagnostic accuracy of the test. Some markers show significant correlations with various immune parameters in head and neck cancer patients and may have a possible role in potentiating the immunodepressed status of such patients. A review of currently reported tumor markers in head and neck cancer showing their nature, sources, uses, and limitations is presented.

Clinical and pathologic prognostic variables in oropharyngeal squamous cell carcinoma

Eighty-five patients with squamous cell carcinoma of the oropharynx were studied to assess the value of histopathologic parameters related to their survival. The overall survival was 58 percent at 3 years and 51 percent at 5 years. Stepwise logistic regression analysis was used to determine the prognostic value of each of the histopathologic features. The extent of in situ carcinoma and presence of multifocality were positive predictors of survival, and perineural invasion and nodal involvement on clinical examination were negative predictors. None of the other parameters used in this study attained statistical significance. We conclude that the histologic grade traditionally used to predict clinical behavior may not be useful. Clinical stage, particularly nodal status; perineural invasion; and the multifocal or in situ disease, should be considered in pathologic reports to provide better prognostic profile in oropharyngeal carcinoma.

The correlation of specific variables of tumor differentiation with response rate and survival in patients with advanced head and neck cancer treated with induction chemotherapy

The authors have reported previously that conventionally defined grades of tumor morphology do not correlate with tumor response or survival in advanced squamous cell cancers of the head and neck (SCCHN) treated with cisplatinum combination induction therapy. This lack of correlation may be the result of the imprecision and subjectiveness of the conventional grade determination. To examine this possibility, response and survival were correlated with individual parameters of morphologic differentiation in 136 patients with advanced, untreated SCCHN. A multi-variable analysis of degree of keratinization, number of mitotic figures per high powered field, degree of nuclear differentiation, presence of vascular invasion, intensity of inflammatory response, and invasion pattern of the cancer was performed. The grade of each variable was weighted by assigning a score from 1 to 4, with 1 representing the most differentiated and 4 the least. The cumulative score of each specimen was tallied and assigned to one of three groups, less than 12, 12 to 18, and greater than 18, analogous to the conventional grades of well, moderately, and poorly differentiated, respectively. No correlation between the grade of individual morphologic variables and response to chemotherapy was demonstrated, or between tumor response and cumulative score groups. There was no correlation of the grade of individual morphologic variables or cumulative score groups with survival. Only the survival of patients achieving a complete response to chemotherapy was correlated with the cumulative score groups: 2-year survivals of 84%, 70%, and 46% for less than 12, 12 to 18, and greater than 18, respectively. Multi-parameter analysis of individual features of tumor differentiation is not superior to conventional morphologic analysis in predicting response to chemotherapy or survival in patients with advanced SCCHN.

Histocompatibility antigens in primary and metastatic squamous cell carcinoma of the larynx

A series of 38 primary laryngeal and hypopharyngeal tumours, 15 lymph-node metastases and normal tissue were evaluated in frozen sections for the expression of MHC class I and II antigens, using monomorphic monoclonal antibodies (MAbs) to HLA-ABC, beta 2-microglobulin, DR, DP, DQ, HLA-B and polymorphic HLA-ABC antigens. Normal distant mucosa of larynx reacted to anti-class I antibodies but not to anti-class II. In 9 primary tumours (23.7%) HLA class I antigens were not observed. The remaining 29 showed a strong reaction to not observed. The remaining 29 showed a strong reaction to anti-HLA-ABC (heavy chain) and anti-beta 2-microglobulin, although in 3 cases out of 29 no staining was observed with anti-HLA-B locus-specific MAbs. These selective losses were confirmed using the corresponding anti-HLA polymorphic MAbs. For HLA class II molecules, only DR was observed in 3 of 38 cases. Defective HLA class I expression statistically correlates with high scores according to Jakobsson's criteria for histopathological tumour grading. Loss of HLA-ABC antigens was most frequent among the cases with poor differentiation (6/8 cases). On the contrary, class II antigen expression was correlated with a well differentiated pattern and a more favourable prognosis (p less than 0.001). We have found differences in HLA class I expression when comparing primary tumours and autologous metastases (3/9 cases). Immunoprecipitation and SDS-PAGE of class I antigens, Northern and Southern blot analyses of MHC class I genes were performed. We have not detected class I gene rearrangement using HLA coding and locus-specific non-coding probes. However, we have found a class I transcription defect that corresponds with a class-I-negative phenotype.

Analysis of survival after induction chemotherapy in pyriform sinus carcinoma

Three hundred seventy-one primary squamous cell carcinomas of the pyriform sinus were treated at Hôpital Laennec from 1970 through 1984 and retrospectively analyzed. The local and regional treatment consisted of initial surgical resection followed by postoperative radiotherapy. Forty-three patients were not treated by induction chemotherapy; 95 patients received preoperative chemotherapy with bleomycin as a single agent; 98 patients received three preoperative courses of vincristine, methotrexate, bleomycin, or endoxan, and 46 patients were treated by three courses of induction chemotherapy consisting of cisplatin, bleomycin, methotrexate, or 5-fluorouracil. Seventy-two patients received less than 150 mg of bleomycin and 17 patients received only one or two cycles of multiple-agent chemotherapy. Survivals were higher when multiple-agent chemotherapy was employed as compared with single-agent induction chemotherapy. Further prospective investigations are necessary to confirm that induction chemotherapy enhances survival in pyriformk sinus cancers.

Lymph node invasion in hypopharynx and lateral epilarynx carcinoma: a prognostic factor

Hypopharynx (HC: pyriform fossa, postcricoïd area, and posterior wall) and lateral epilarynx carcinomas (LEC: aryepiglottic fold, pharyngoepiglottic fold, and arytenoïd) have a high tendency to cervical lymph node invasion. Such nodal extension is a well-known prognostic factor. This study is based on a retrospective review of 884 clinical records of previously untreated HC or LEC. Seventy percent of patients revealed palpable nodes at their first examination, with a higher percentage for HC (73%) than LEC (62%). The 5-year survival rate was divided by three in the presence of contralateral, bilateral, or fixed nodes, or in cases of nodes exceeding 3 cm. Multiple positive nodes, extracapsular spread, or lower-neck positive nodes significantly decreased survival, doubled the number of neck recurrences, and tripled the number of distant metastases while control at the primary site remained unvaried.

Squamous cell carcinoma of the pyriform sinus: retrospective study of 351 cases treated at the Institut Gustave-Roussy

The first part of the study was devoted to 199 tumors treated by surgery, either conservative for the smallest tumors (18 cases) or radical (181 cases), with systematic postoperative radiotherapy. The 3-year survival rate was 48% and the 5-year, 33%, with a 12% local recurrence rate, a 7.5% neck recurrence rate, and 27.6% rate distant metastases. Histologic correlations were developed. The second part of the study reported 152 cases treated by external radiotherapy alone either as a variant of our treatment protocol for the small-sized tumors (31 cases) or, for the major part (121 cases), as a result of surgical inoperability or patient refusal. The former subgroup had a variable survival rate (65% at 3 years and 40% at 5 years) equivalent to similarly staged patients treated with conservation laryngeal surgery, whereas the prognosis of the latter subgroup was poor. The two main causes of failure were the inability to apply the curative treatment protocol in 35% of patients ineligible for a surgery and the high risk of distant metastases in the 65% of patients able to undergo the usual management.

The impact of conventional morphologic analysis on response rates and survival in patients with advanced head and neck cancers treated initially with cisplatin-containing combination chemotherapy

The response to initial treatment with cisplatin-containing combination chemotherapy as well as survival, were correlated with tumor differentiation (well, moderate or poorly differentiated) in 164 patients with advanced, untreated squamous cell carcinoma of the head and neck. Thirty-three percent of the tumors were graded as poorly differentiated, 59% moderately differentiated, and 8% were well differentiated. The overall clinical response rates were nearly equal for the three grades of differentiation: 79% for well differentiated, 86% for moderately differentiated, and 89% for poorly differentiated. The complete response rate was somewhat higher for poorly differentiated tumors: 46% as compared to 32% and 29% for moderately and well differentiated respectively, but the differences were not statistically significant. The median survival for each morphologic group was 22, 16, and 12 months for well differentiated, moderately differentiated and poorly differentiated tumor, respectively (P = 0.097). For patients achieving a complete clinical response to chemotherapy, there was a difference in survival when stratified according to degree of histologic differentiation. Patients who were complete responders and had well or moderately differentiated tumors attained 75% and 38% survival at 36 months, respectively, versus 19% for patients with complete response and poorly differentiated tumors (P = 0.064). The degree of differentiation of previously untreated squamous cell cancers of the head and neck does not conclusively predict tumor response to combination chemotherapy, but may reflect differences in natural history. Survival is improved in patients with differentiated tumors as compared to those with poorly differentiated tumors. Morphologic grading in patients achieving a complete response reveals a decrease in survival for patients with poorly differentiated tumors.

The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus

The incidence of palpable and occult cancer and the absence of cancer in lymph nodes were determined for individual sites in the larynx and pharynx of 540 patients who underwent neck dissection. The incidence of palpable cancer in lymph nodes was lowest for cancers of the central supraglottis and transglottis (32-41%), intermediate for cancers of the marginal supraglottis and glossoepiglottis (48-57%), and highest for cancers of the pyriform sinus (69%). The incidence of occult cancer in lymph nodes for individual sites in the larynx and pharynx was determined by pathologic study of neck dissection specimens from 253 patients without palpable lymph nodes (NO neck). The incidence of occult lymphatic metastases in the NO neck and the need for elective neck irradiation were least for cancers of the transglottis and central supraglottis (14-16%), intermediate for cancers of the glossoepiglottis and the marginal supraglottis (20-38%), and greatest for cancers of the pyriform sinus (47%). The risk of nodal recurrence increased from 8% for those without cancer in lymph nodes to 38% for those with occult or palpable cancer in lymph nodes. A policy of observing the NO neck in patients with a low incidence of occult lymphatic metastases and a low risk of neck recurrence to avoid the unnecessary irradiation of many to benefit a few is discussed.

Hypopharyngeal cancer: results of treatment with radiotherapy alone and combinations of surgery and radiotherapy

From 1962 to 1977, 90 patients with hypopharyngeal cancer were seen in the Academic Hospital in Leuven. Radiotherapy was the primary treatment in 66 patients, actuarial survival was 18% at 5 years and local control 22%. In 22 patients treated with a laryngopharyngectomy and pre- or postoperative radiotherapy, survival was also 18%, but local control was obtained in 51%. No differences in prognosis were demonstrated according to the tumoral stage or nodal status. Metastases were found in 10.5% of irradiated patients and in 14% of patients treated with combined therapy. The frequency of postoperative complications was not increased after surgery for preoperatively irradiated patients. Treatment results in hypopharyngeal cancer remain unfavorable, even with a combination of surgery and radiotherapy. Alternative approaches should be actively investigated to improve local control rates such as the modalities currently under study (high LET, new fractionations, combinations with drugs).

Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx

Seventy-seven patients with squamous cell carcinoma of the oropharynx were treated by preoperative radiation therapy (4000-5000 rad) followed by surgical resection. The original biopsy specimens were evaluated for degree of keratinization, nuclear pleomorphism, frequency of mitoses, inflammatory response, vascular invasion, and pattern of invasion. Multivariant analysis (Cox regression model) and life table survival function were used to determine the relative contributions of the clinical and histologic parameters to patient outcome. The results were as follows: (1) large tumor size, nodal metastases, and male sex were found to be predictive of a poorer survival (P = 0.004, 0.0167, and 0.0237, respectively); and (2) an analysis of a combination of clinical and histologic parameters demonstrated that the pattern of invasion was the only histologic factor that was predictive of survival (P = 0.0436). Neoplasms invading as large cohesive aggregates indicated a better prognosis than neoplasms invading as thin, irregular cords or individual cells. Restricting the statistical evaluation to only histologic factors (excluding clinical factors) demonstrated that increased frequency of mitoses also correlated with poor survival (P = 0.0218). Further restriction of the analysis to T2 and T3 neoplasms that have similar survival times indicated that both frequency of mitoses and pattern of invasion were of prognostic value in predicting survival (P = 0.0127 and 0.0168, respectively).

Carcinoma of the pyriform sinus: analysis of 102 cases

The treatment of 102 patients with squamous cell carcinoma of the pyriform sinus seen at the University of Virginia Medical Center from 1958 through 1977 is reviewed. Eight-seven cases form the basis for this report. Surgery alone, radiation alone and combination of the two were the treatment modalities utilized for the patients in this study. The overall 3 year, no evidence of disease determinate survival was (37%). Recent literature has suggested that preoperative radiation obscures tumor margins with a decrease in survivals as compared to postoperative irradiation. Though the number of patients in both the preoperative (27) and postoperative (7) groups are small, our data suggests similar survivals. In addition, when pathology was examined, no tumor margins were transected in the preoperative irradiation group and only 5/23 patients had margins classified as close. The incidence of postoperative complications was not significantly difference between the combination therapy and surgery only groups. It is concluded that preoperative irradiation does not compromise the resection of adequate tumor margins nor significantly increase postoperative complications.