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Guo LF, Hong JG, Wang RJ, Chen GP, Wu SG. Nasopharyngeal carcinoma survival by histology in endemic and non-endemic areas. Ann Med 2024; 56:2425066. [PMID: 39529559 PMCID: PMC11559018 DOI: 10.1080/07853890.2024.2425066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/11/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND To investigate the prognostic implications of histology among nasopharyngeal carcinoma (NPC) using the data from a Chinese cohort and the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We included patients diagnosed with WHO II and III subtypes NPC from two independent cohorts (Xiamen [XM]-NPC cohort and SEER-NPC cohort). RESULTS We identified 726 patients in the XM-NPC cohort and 1334 patients in the SEER cohort. In the XM-NPC cohort, 94 (12.9%) and 632 (87.1%) patients had WHO II and III subtypes, respectively. In the SEER-NPC cohort, 839 (62.9%) and 495 (37.1%) patients had WHO II and III subtypes, respectively. WHO II subtype patients had a higher smoking rate than the WHO III subtype (57.4% vs. 43.4%) in the XM-NPC cohort. There were no significant differences in age, gender, tumor stage, or nodal stage between the two subtypes in both cohorts. In the XM-NPC cohort, patients with the WHO II subtype had worse locoregional relapse-free survival (82.2% vs. 89.5%, p = 0.063), distant metastasis-free survival (72.4% vs. 85.9%, p = 0.028), disease-free survival (61.6% vs. 78.8%, p = 0.003), and overall survival (OS) (71.7% vs. 84.0%, p = 0.035) than those with WHO III subtype. In the SEER-NPC cohort, patients with the WHO II subtype had worse NPC-specific survival (81.1% vs. 89.4%, p < 0.001) and OS (71.6% vs. 78.8%, p < 0.001) than those with WHO III subtype. The multivariate analysis showed that histology was an independent prognostic factor associated with outcomes in both cohorts. CONCLUSIONS Our study demonstrates the significant influence of histological subtypes on outcomes in NPC among various populations, highlighting substantial disparities between the WHO II and WHO III subtypes.
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Affiliation(s)
- Lin-Feng Guo
- Department of Radiation Oncology, Xiamen Cancer Quality Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Jia-Geng Hong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Anesthesiology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Run-Jie Wang
- Department of Radiation Oncology, Xiamen Cancer Quality Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Gui-Ping Chen
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, People’s Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Quality Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
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Wang ZM, Zhu SY, Wang Q, Duan CY, Liu SH, You R, Chen MY, Huang PY. Role of combined surgical and radiotherapy treatment in nonmetastatic WHO I nasopharyngeal carcinoma patients. Acta Otolaryngol 2024; 144:325-332. [PMID: 39033361 DOI: 10.1080/00016489.2024.2378467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Keratinizing squamous cell carcinoma (KSCC) is recognized as WHO I nasopharyngeal carcinoma (NPC). Current guidelines for treating nasopharyngeal cancer do not delineate specific strategies for individual pathologic subtypes. OBJECTIVES To explore the optimal treatment for KSCC of the nasopharynx. MATERIAL AND METHODS Data on patients were extracted from the SEER database. Survival differences between patients treated with radiotherapy alone and combined surgery were assessed using Kaplan-Meier and Cox regression models and compared using propensity score matching (PSM). In addition, we explored the survival differences between the two groups of patients in different risk stratifications. RESULTS In our study, 165 patients underwent surgical intervention, while 1238 patients did not. In both univariate (CSS: p = .001, HR = 0.612; OS: p < .001, HR = 0.623) and multivariate (CSS: p = .004, HR = 0.655; OS: p < .001, HR = 0.655) analyses, combined surgery was identified as a significant prognostic factor. These findings were consistent after PSM. Using RPA, patients were categorized into two groups. CSS improved in the high-risk group, whereas the difference in low-risk patients was not significant. CONCLUSIONS AND SIGNIFICANCE For patients diagnosed with WHO I nasopharyngeal carcinoma, the combination of radiotherapy and surgery has significant clinical advantages, especially for patients at high risk.
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Affiliation(s)
- Zi-Meng Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Si-Yu Zhu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qin Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Si-Han Liu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui You
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Sun Yat-sen University Cancer Center, Guangzhou, China
- Nasopharyngeal Cancer Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ming-Yuan Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Sun Yat-sen University Cancer Center, Guangzhou, China
- Nasopharyngeal Cancer Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Pei-Yu Huang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Sun Yat-sen University Cancer Center, Guangzhou, China
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Lian CL, Zhou R, Zhou Y, Zhou P, Wu SG. Assessment of Response to Different Induction Chemotherapy Regimens in Locally Advanced Nasopharyngeal Carcinoma. Drug Des Devel Ther 2023; 17:551-562. [PMID: 36855516 PMCID: PMC9968429 DOI: 10.2147/dddt.s399937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
Purpose To compare the short-term treatment response and survival of the three induction chemotherapy (IC) regimens, including gemcitabine and cisplatin (GP), docetaxel and cisplatin (TP), and docetaxel, cisplatin, and fluoropyrimidines (TPF) in locally advanced nasopharyngeal carcinoma (LANPC). Methods We included stage III-IVA NPC patients who received ≥3 cycles of IC in this study. The chi-square test, multivariate logistic regression analysis, and Kaplan-Meier method were used for statistical analysis. Results A total of 227 patients were included. The overall response rate (ORR) of the primary nasopharyngeal tumors after IC with GP, TP, and TPF was 91.9%, 83.8%, and 91.7%, respectively (P=0.729), and the ORR of the cervical lymph nodes was 94.6%, 72.3%, and 85.0%, respectively (P<0.001). For the primary nasopharyngeal tumor, there was no significant difference in the ORR among the three IC regimens. For cervical lymph nodes, patients treated with GP had significantly higher ORR compared to those treated with the TP regimen (P=0.014), and comparable ORR was found between TPF and GP regimens (P=0.161). Similar progression-free survival (PFS) (P=0.501) and overall survival (OS) (P=0.504) were found among three IC regimens. There were comparable PFS (P=0.123) and OS (P=0.478) among those with complete response (CR), partial response (PR), and stable disease (SD)/progressive disease (PD) in the primary nasopharyngeal tumors. However, patients who had CR in the primary nasopharyngeal tumor (P=0.014) and the cervical lymph nodes (P=0.022) had better PFS compared to those who had PR or SD/PD. Conclusion GP and TPF regimens are equivalent to the TP regimen in the response to primary nasopharyngeal tumors after IC, but with better ORR in the cervical lymph nodes than the TP regimen. The response to IC may be a powerful indicator for predicting prognosis and developing individualized follow-up and treatment strategies for LANPC patients.
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Affiliation(s)
- Chen-Lu Lian
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China,Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China,Department of Radiation Oncology, Fudan University Shanghai Cancer Center (Xiamen Branch), Xiamen, People's Republic of China
| | - Rui Zhou
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Yuan Zhou
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Ping Zhou
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - San-Gang Wu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China,Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China,Correspondence: San-Gang Wu, Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People’s Republic of China, Email
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Stepan KO, Mazul AL, Skillington SA, Paniello RC, Rich JT, Zevallos JP, Jackson RS, Pipkorn P, Massa S, Puram SV. The prognostic significance of race in nasopharyngeal carcinoma by histological subtype. Head Neck 2021; 43:1797-1811. [PMID: 33620125 PMCID: PMC8480514 DOI: 10.1002/hed.26639] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 12/16/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Race has been shown to have variable prognostic importance in nasopharyngeal carcinoma (NPC). However, previous studies are limited by a lack of comprehensive treatment, epidemiologic, and comorbidity data. METHODS This was a retrospective cohort study utilizing the National Cancer Database from 2004 to 2016. Multivariable Cox proportional hazards regressions were used to calculate adjusted hazard ratios (aHR) for overall survival. RESULTS A cohort of 9995 patients met inclusion and exclusion criteria. Race, insurance, comorbidity, treatment, stage, age, and histology were independent prognosticators. Among patients with keratinizing NPC, Asians and Hispanics had superior survival (aHR 0.58 [95% confidence interval (CI) 0.48-0.69], aHR 0.76 [95% CI 0.61-0.96]) compared to white patients. Among patients with non-keratinizing differentiated NPC, Asians and black patients had improved survival (aHR 0.71 [95% CI 0.56-0.91], aHR 0.72 [95% CI 0.54-0.95]) compared to white patients. Race was not prognostic in non-keratinizing undifferentiated NPC. CONCLUSION The prognostic significance of race varies across histological subtypes of NPC.
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Affiliation(s)
- Katelyn O. Stepan
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Angela L. Mazul
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St Louis, MO
| | - S. Andrew Skillington
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Randal C. Paniello
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Jason T. Rich
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Jose P. Zevallos
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Ryan S. Jackson
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Sean Massa
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
| | - Sidharth V. Puram
- Department of Otolaryngology, Washington University School of Medicine, St Louis, MO
- Department of Genetics, Washington University School of Medicine, St Louis, MO
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Wu SG, Lian CL, Wang J, Zhang WW, Sun JY, Lin Q, He ZY. The effect of histological subtypes on survival outcome in nasopharyngeal carcinoma after extensive follow up. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:768. [PMID: 32042784 DOI: 10.21037/atm.2019.11.75] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background No consensus exists regarding the follow-up of nasopharyngeal carcinoma (NPC) patients stratified by different histological subtypes. The purpose of this study was to determine the hazard function of disease-related death and assess the prognostic effect of early and late disease-related death in NPC according to histological subtypes. Methods We included non-metastatic NPC patients between 2004 and 2014 using the Surveillance, Epidemiology and End-Results (SEER) program. Life-table methods, Kaplan-Meier methods, and a multivariate Cox regression model were used in the analysis. Results We identified 2,845 patients in this study including 1,218 (42.8%), 849 (29.8%), and 778 (27.3%) patients with keratinizing squamous cell carcinoma (KSCC), differentiated non-keratinizing carcinoma (DNKC), and undifferentiated non-keratinizing carcinoma (UNKC), respectively. Most NPC-related death (89.8%) occurred within 5 years of diagnosis. In the entire cohort, the hazard curve for NPC-related death peaked at 2 years. It peaked at 1 year, 2- and 5-year, and 2- and 6-year in patients with KSCC, DNKC, and UNKC, respectively. Within the follow-up period over 5 years, patients with DNKC had poorer NPC-specific survival (NPC-SS) compared to UNKC, and had comparable NPC-SS between the two subtypes after more than 5 years of follow-up. Moreover, within the follow-up period of 1, 2, and 3 years, patients with KSCC experienced poorer NPC-SS compared to UNKC but there was comparable NPC-SS between KSCC and UNKC patients after more than 3 years of follow-up. Conclusions The hazard rate patterns for NPC-related mortality significantly differed between histological subtypes. Tailored surveillance and follow-up strategies should be designed in NPC patients according to histological subtypes.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Chen-Lu Lian
- Department of Radiation Oncology, Cancer Hospital, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Jun Wang
- Department of Radiation Oncology, Cancer Hospital, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Qin Lin
- Department of Radiation Oncology, Cancer Hospital, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
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Lymph Node Status and Outcomes for Nasopharyngeal Carcinoma According to Histological Subtypes: A SEER Population-Based Retrospective Analysis. Adv Ther 2019; 36:3123-3133. [PMID: 31559602 DOI: 10.1007/s12325-019-01100-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We aimed to investigate the clinical effect of histological subtypes on survival in nasopharyngeal carcinoma (NPC), and assess the effect of nodal stage on outcome according to histological subtypes. METHODS Patients with non-metastatic NPC were identified from the Surveillance, Epidemiology and End-Results (SEER) database between 2004 and 2014. Statistical analysis was performed using the chi-squared test, Kaplan-Meier methods, and multivariate Cox regression models. RESULTS We identified 2845 patients in this study including 1218 (42.8%), 849 (29.8%), and 778 (27.3%) patients with keratinizing squamous cell carcinoma (KSCC), differentiated non-keratinizing squamous cell carcinoma (DNKSCC), and undifferentiated non-keratinizing squamous cell carcinoma (UNKSCC), respectively. The multivariate analysis indicated that patients with UNKSCC subtype had better NPC-specific survival (NPC-SS) (P < 0.001) compared to KSCC (P < 0.001) and DNKSCC (P < 0.001) patients. The 5-year NPC-SS was 75.2%, 77.9%, and 88.9% in patients with KSCC, DNKSCC, UNKSCC, respectively (P < 0.001). Subgroup analysis showed that advanced nodal stage was related to lower NPC-SS in patients with DNKSCC and UNKSCC but not in patients with KSCC. CONCLUSIONS Histology is an independent prognostic factor in patients with NPC. However, advanced nodal stage is not associated with lower survival in KSCC.
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Yang L, Wei W, Zhou L, Wang J, Hu G. High/positive expression of ERCC1 predicts poor treatment response and survival prognosis in nasopharyngeal carcinoma: A systematic meta-analysis from 21 studies. Medicine (Baltimore) 2019; 98:e15641. [PMID: 31124943 PMCID: PMC6571253 DOI: 10.1097/md.0000000000015641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Excision repair cross-complementation group 1 (ERCC1) protein is a member of the nucleotide excision repair (NER) system, which plays an important role in DNA damage repair. Recently, its predictive and prognostic value in nasopharyngeal carcinoma (NPC) has been investigated by several studies. However, their results remain controversial. OBJECTIVES In an attempt to address this issue, we conducted the present comprehensive meta-analysis. DATA SOURCES Studies published until November 2017 were searched. Finally, total 21 literatures involving 22 cohorts and 2921 NPC patients fulfilled the inclusion criteria. RESULTS The pooled results showed that high/positive expression of ERCC1 predicted poor objective response rate (ORR) [odds ratio (OR) = 2.83; 95% confidence interval (CI) = 2.11-3.80; P <.001], overall survival (OS) [hazard ratio (HR) = 1.77; 95% CI = 1.48-2.12; P <.001], and disease-free survival (DFS) (HR = 1.60; 95% CI = 1.43-1.79; P <.001) in NPC. Low heterogeneity was detected among these studies (ORR: I = 0.0%, P = .776; DFS: I = 38.7%, P = .148; OS: I = 0.0%; P = .530). The results of sensitivity analyses and publication bias verified the reliability of our findings. CONCLUSIONS This study suggested ERCC1 as a potential predictive and prognostic biomarker for the treatment response and survival prognosis of NPC patients.
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Affiliation(s)
- Lin Yang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
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Induction chemotherapy followed by concurrent chemoradiotherapy is benefit for advanced stage nasopharyngeal carcinoma with different nonkeratinizing carcinoma subtypes. Sci Rep 2018; 8:13318. [PMID: 30190563 PMCID: PMC6127191 DOI: 10.1038/s41598-018-31050-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022] Open
Abstract
Given the potentially distinctive histological variations in northwest of China, the aim of current study was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy (IC + CCRT) with concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients with different histological types. A total of 301 patients were included in this study. Patients were classified in two cohorts according to the 2005 WHO World Health Organization histological classification: WHO type IIa group and WHO type IIb group. The Kaplan-Meier method was used to detect the efficacy between IC + CCRT and CCRT in two WHO types cohorts. Propensity score matching method was adopted to balance the baseline covariate and eliminate potential selection bias. On propensity matched analyses, IC + CCRT was found to produce better 3-year DMFS and OS than CCRT in WHO type IIa cohort (DMFS, 76.2% vs. 42.2%, p = 0.029; OS, 78.3% vs. 65.5%, p = 0.027). For WHO type IIb cohort, IC + CCRT was associated with a better 3-year OS (87.4% vs. 77.9%, p = 0.029) and a trend of better 3-year DMFS (85.9% vs. 76%, p = 0.162) compared with CCRT. IC + CCRT was benefit for advanced stage nasopharyngeal carcinoma with different nonkeratinizing carcinoma subtypes.
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Rao S, Beckman RA, Riazi S, Yabar CS, Boca SM, Marshall JL, Pishvaian MJ, Brody JR, Madhavan S. Quantification and expert evaluation of evidence for chemopredictive biomarkers to personalize cancer treatment. Oncotarget 2018; 8:37923-37934. [PMID: 27888622 PMCID: PMC5514962 DOI: 10.18632/oncotarget.13544] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/12/2016] [Indexed: 02/06/2023] Open
Abstract
Predictive biomarkers have the potential to facilitate cancer precision medicine by guiding the optimal choice of therapies for patients. However, clinicians are faced with an enormous volume of often-contradictory evidence regarding the therapeutic context of chemopredictive biomarkers. We extensively surveyed public literature to systematically review the predictive effect of 7 biomarkers claimed to predict response to various chemotherapy drugs: ERCC1-platinums, RRM1-gemcitabine, TYMS-5-fluorouracil/Capecitabine, TUBB3-taxanes, MGMT-temozolomide, TOP1-irinotecan/topotecan, and TOP2A-anthracyclines. We focused on studies that investigated changes in gene or protein expression as predictors of drug sensitivity or resistance. We considered an evidence framework that ranked studies from high level I evidence for randomized controlled trials to low level IV evidence for pre-clinical studies and patient case studies. We found that further in-depth analysis will be required to explore methodological issues, inconsistencies between studies, and tumor specific effects present even within high evidence level studies. Some of these nuances will lend themselves to automation, others will require manual curation. However, the comprehensive cataloging and analysis of dispersed public data utilizing an evidence framework provides a high level perspective on clinical actionability of these protein biomarkers. This framework and perspective will ultimately facilitate clinical trial design as well as therapeutic decision-making for individual patients.
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Affiliation(s)
- Shruti Rao
- Innovation Center for Biomedical Informatics, Georgetown University, Washington, DC, USA
| | - Robert A Beckman
- Innovation Center for Biomedical Informatics, Georgetown University, Washington, DC, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Shahla Riazi
- Innovation Center for Biomedical Informatics, Georgetown University, Washington, DC, USA
| | - Cinthya S Yabar
- Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Simina M Boca
- Innovation Center for Biomedical Informatics, Georgetown University, Washington, DC, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - John L Marshall
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Michael J Pishvaian
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jonathan R Brody
- Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics, Georgetown University, Washington, DC, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Xu S, Yu Y, Rong J, Hu D, Zhang L, Fu S, Yang H, Fan J, Yang L, Wu J. Expression of BRCA1 and ERCC1 as predictive clinical outcome after radiochemotherapy in patients with locoregionally moderate-advanced nasopharyngeal carcinoma. Oncotarget 2018; 8:31355-31367. [PMID: 28404895 PMCID: PMC5458213 DOI: 10.18632/oncotarget.15565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/26/2017] [Indexed: 01/18/2023] Open
Abstract
In this study, we examined ERCC1 and BRCA1 expression and clinical outcome of 201 phase-III-IV nasopharyngeal carcinoma patients who were treated with cisplatin-based induced chemotherapy and concurrent radiochemotherapy. The chemotherapy response rate of BRCA1– and BRCA1+ patients was 73.6% and 55.8%, respectively. In addition, the chemotherapy response rate of ERCC1– and ERCC1+ patients was 76.9% and 56.6%, respectively. In patients’ tissues, ERCC1 expression associated with BRCA1 expression. The chemotherapy response rate of BRCA1– and ERCC1– patients was (82.1%) and higher than that of other groups (range 52.4-73.1%). The radiochemotherapy response rate of BRCA1– and ERCC1– patients was higher than that BRCA1+ and ERCC1+ patients. BRCA1– and ERCC1– patients showed higher 3-year overall survival, failure-free survival, locoregional failure-free survival and distant failure-free survival compared to BRCA1+ or ERCC1+ patients. Moreover, the 3-year overall survival, failure-free survival and distant failure-free survival of the BRCA1– and ERCC1– group were higher than that of other groups. TNM stage, ERCC1 expression and the correlation between BRCA1 and ERCC1 expression seemed significant overall survival factors. In conclusion, in nasopharyngeal carcinoma patients, ERCC1 and BRCA1 may be a predictor of response to platinum-based chemotherapy and concurrent radiochemotherapy.
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Affiliation(s)
- Shan Xu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Yanxin Yu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Jinfeng Rong
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Defeng Hu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - LiJun Zhang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Hongru Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Juan Fan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Linglin Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, P. R. China
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11
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Wang D, Zhou J, Zheng J, Zhang J, Chen Y, Li W, Wang R. Predictive value of excision repair cross- complementation group 1 expression in locoregionally advanced nasopharyngeal carcinoma receiving cisplatin-based concurrent chemoradiotherapy. Cancer Biomark 2018; 21:875-881. [PMID: 29439312 DOI: 10.3233/cbm-170817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dong Wang
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Juan Zhou
- Department of Oncology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, Guangdong, China
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Jihua Zheng
- Department of Oncology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, Guangdong, China
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Jiang Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Yaoming Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Wen Li
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Ruizhi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
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12
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Gemcitabine monotherapy in patients with heavily treated nasopharyngeal cancer: a case series. Int J Clin Oncol 2017; 22:1009-1014. [PMID: 28616753 DOI: 10.1007/s10147-017-1152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although gemcitabine is thought to play a critical role in the treatment of nasopharyngeal cancer, no research to evaluate the efficacy and toxicity of gemcitabine monotherapy has been conducted in Japan. METHODS We retrospectively reviewed eight nasopharyngeal carcinoma patients treated with gemcitabine monotherapy at National Cancer Center Hospital East between May 2015 and August 2016. The main eligibility criteria were (1) histopathologically proven NPC; (2) tumor recurrence or an initial M1 TNM stage diagnosis; (3) at least two other types of systemic chemotherapy prior to gemcitabine; (4) no other active malignant tumor during treatment. RESULTS All patients were administered gemcitabine 800-1000 mg/m2 on days 1, 8, and 15, repeated every 4 weeks. Gemcitabine was given as third-line systemic chemotherapy in six (74%) patients, as fourth-line in one (13%) and as fifth-line in one (13%). One patient had a complete response and one had a partial response, giving an overall response rate of 25%; four patients (50%) had stable disease and two (25%) experienced disease progression. The main toxicity was myelosuppression, with grade 3 leukopenia in three (38%) patients and neutropenia in four (50%). There were no treatment-related deaths. Median dose intensity and relative dose intensity of gemcitabine were 620 mg/m2/week and 97.5%, respectively. CONCLUSION Our findings suggest that GEM monotherapy is well tolerated and has potential as an active agent in Japanese patients with recurrent/metastatic NPC who have been heavily pretreated.
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13
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Palliative systemic therapy for recurrent or metastatic nasopharyngeal carcinoma – How far have we achieved? Crit Rev Oncol Hematol 2017; 114:13-23. [DOI: 10.1016/j.critrevonc.2017.03.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/28/2017] [Indexed: 02/05/2023] Open
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14
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Bišof V, Zajc Petranović M, Rakušić Z, Samardžić KR, Juretić A. The prognostic and predictive value of excision repair cross-complementation group 1 (ERCC1) protein in 1288 patients with head and neck squamous cell carcinoma treated with platinum-based therapy: a meta-analysis. Eur Arch Otorhinolaryngol 2015; 273:2305-17. [PMID: 26179868 DOI: 10.1007/s00405-015-3710-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
Excision repair cross-complementation group 1 (ERCC1) protein has been extensively investigated as a prognostic and predictive factor for platinum-based treatment in head and neck squamous cell carcinoma (HNSCC) but with inconsistent results. We performed the present meta-analysis to better elucidate this issue in advanced HNSCC. A literature search was conducted using the PubMed and Web of Science databases. The inclusion criteria were head and neck cancer patients with platinum-based treatment and evaluation of the correlation between ERCC1 expression and clinical outcomes [objective response rate (ORR), progression-free survival (PFS), and overall survival (OS), both unadjusted and adjusted estimates]. In high vs. low pooled analyses, high ERCC1 expression was associated with unfavorable OS [hazard ratio (HR) = 1.95, 95 % confidence interval (CI) 1.18-3.21, p = 0.009], PFS (HR = 2.39, 95 % CI 1.74-3.28, p = 0.000) and ORR (odds ratio = 0.48, 95 % CI 0.23-0.98, p = 0.044). In the subgroup analysis of adjusted OS estimates, ERCC1 was a predictor of shorter survival in Asians (HR = 3.13, 95 % CI 2.09-4.70, p = 0.000) and Caucasians (HR = 2.02, 95 % CI 1.32-3.07, p = 0.001) but of longer survival in South Americans (HR = 0.17, 95 % CI 0.07-0.40, p = 0.000). Immunohistochemistry proved to be of predictive value irrespective of used antibody (p = 0.009). In the stratified analysis according to the tumor site, ERCC1 expression was associated with OS in nasopharyngeal cancer (HR = 2.72, 95 % CI 1.79-4.13, p = 0.000). ERCC1 has a potential to become predictive and prognostic factor enabling treatment tailoring in HNSCC patients.
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Affiliation(s)
- Vesna Bišof
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia. .,School of Medicine, University of Osijek, Osijek, Croatia.
| | | | - Zoran Rakušić
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | | | - Antonio Juretić
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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15
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Ko JJ, Klimowicz AC, Jagdis A, Phan T, Laskin J, Lau HY, Siever JE, Petrillo SK, Thomson TA, Rose MS, Bebb G, Magliocco AM, Hao D. ATM, THMS, and RRM1 protein expression in nasopharyngeal carcinomas treated with curative intent. Head Neck 2015; 38 Suppl 1:E384-91. [PMID: 25640951 DOI: 10.1002/hed.24004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In advanced nasopharyngeal carcinoma (NPC), biomarkers may help predict survival. METHODS Tumoral expression of ataxia-telangiectasia mutated (ATM), thymidylate synthetase (THMS), and ribonucleotide reductase subunit M1 (RRM1), was correlated with survival in patients with nonmetastatic NPC using quantitative fluorescence immunohistochemistry with automated quantitative digital image analysis. RESULTS Of the 146 patients included, 58 patients (40%) received concurrent chemoradiation therapy; the remainder was treated with radiation. Overall survival (OS) at 5 years was 71% (95% confidence interval [CI], 62% to 78%); disease-free survival (DFS) was 48% (95% CI, 39% to 57%). OS worsened for increasing values of ATM (hazard ratio [HR], 2.83; 95% CI, 1.01-7.94; p = .049) for values greater than the 75th percentile compared to less than the 25th percentile, but improved for tumors with higher THMS levels (HR, 0.44; 95% CI, 0.20-0.94; p = .033) for values greater than the 25th percentile compared to less than or equal to the 25th percentile. RRM1 was not associated with OS (p = .748). No biomarkers were associated with DFS. CONCLUSION In our cohort, relative overexpression of ATM and low THMS levels were associated with worse OS. © 2015 Wiley Periodicals, Inc. Head Neck 38: E384-E391, 2016.
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Affiliation(s)
- Jenny Jaeeun Ko
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Alexander C Klimowicz
- Functional Tissue Imaging Unit, Translational Research Laboratory, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Jagdis
- Department of Allergy and Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tien Phan
- Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Janessa Laskin
- Department of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harold Y Lau
- Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jodi E Siever
- Department of Biostatistics, Public Health Innovation & Decision Support Population and Public Health, Alberta Health Services, Alberta, Canada
| | - Stephanie K Petrillo
- Functional Tissue Imaging Unit, Translational Research Laboratory, University of Calgary, Calgary, Alberta, Canada
| | - Thomas A Thomson
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - M Sarah Rose
- Department of Biostatistics, Research Facilitation, Alberta Health Services, Alberta, Canada
| | - Gwyn Bebb
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anthony M Magliocco
- Department of Anatomic Pathology, Esoteric Laboratory Services, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Desirée Hao
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Biau J, Chautard E, Miroir J, Lapeyre M. [Radioresistance parameters in head and neck cancers and methods to radiosensitize]. Cancer Radiother 2015; 19:337-46; quiz 360-1, 363. [PMID: 26119219 DOI: 10.1016/j.canrad.2015.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 12/24/2022]
Abstract
Head and neck cancers have been widely studied concerning their sensitivity to radiation therapy. Several parameters affect tumour response to radiation therapy. Some parameters are linked to the tumour. Large or invasive tumours, localization, such as oral cavity or adenopathy, are factors of radioresistance. Others parameters are linked to the patients themselves. Tobacco intoxication during radiotherapy and a low hemoglobin level contribute to radioresistance. More recently, a positive human papilloma virus (HPV) status has been reported to positively affect radiosensitivity. Finally, other parameters are related to tumour biology. Hypoxia, intrinsic radiosensitivity of tumour cells, tumour differentiation and repopulation (provided by Ki-67 index or EGFR level) are components of radiosensitivity. Currently, concurrent chemoradiotherapy is one of the gold standard treatments to overcome clinical outcome of locally advanced head and neck cancer. This combination increases locoregional control and survival. Taxane-based induction chemotherapy can also be an alternative. Another validated approach is the association of radiotherapy with cetuximab (EGFR targeting) but only one randomized study has been published. Fractionation modifications, especially hyperfractionation, have given positive results on both tumour control and survival. Strategies targeting hypoxia improve locoregional control but have less clinical impact.
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Affiliation(s)
- J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France; EA7283 Cancer Resistance Exploring and Targeting (CREAT), Clermont université, université d'Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand cedex 1, France; Équipe recombinaison, réparation et cancer, UMR 3347, CNRS, centre universitaire, 91405 Orsay cedex, France; Inserm U1021, centre universitaire, 91405 Orsay cedex, France; Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - E Chautard
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France; EA7283 Cancer Resistance Exploring and Targeting (CREAT), Clermont université, université d'Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
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17
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Hui EP, Ma BBY, Chan KCA, Chan CML, Wong CSC, To KF, Chan AWH, Tung SY, Ng WT, Cheng AC, Lee VHF, Chan SL, Loong HHF, Kam MKM, Leung SF, Ho R, Mo F, Ngan RKC, Chan ATC. Clinical utility of plasma Epstein-Barr virus DNA and ERCC1 single nucleotide polymorphism in nasopharyngeal carcinoma. Cancer 2015; 121:2720-9. [PMID: 25946469 DOI: 10.1002/cncr.29413] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/22/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Single nucleotide polymorphism (SNP) of the excision repair cross-complementing group 1 (ERCC1) gene has been linked with sensitivity to platinum and radiation. The authors hypothesized that the ERCC1 genotype for the SNPs cytosine-to-thymine substitution at codon 118 (C118T) and cytosine-to-adenine substitution at codon 8092 (C8092A) is prognostic in patients with nasopharyngeal carcinoma (NPC) who receive either radiotherapy (RT) or cisplatin plus RT. METHODS The authors tested their hypothesis using biomarker screening samples from the Hong Kong NPC Study Group 0502 trial, which was a prospective, multicenter clinical trial that used post-RT plasma Epstein-Bar virus (EBV) DNA (pEBV) levels to screen patients with high-risk NPC for adjuvant chemotherapy. RESULTS ERCC1 SNPs were analyzed in 576 consecutive patients who were screened by pEBV. In the total biomarker population, there was no significant association of ERCC1 C118T or C8092A genotype with relapse-free survival (RFS) or overall survival (OS). There also was no correlation between ERCC1 genotype and ERCC1 protein or messenger RNA expression in a subset of patients who had available paired biopsies. Post-RT pEBV status was the only independent prognosticator for RFS and OS in multivariate analyses. However, there was a significant interaction between ERCC1 C118T genotype and post-RT pEBV status (RFS, P = .0106; OS, P = .0067). The ERCC1 C118T genotype was significantly associated with both RFS (hazard ratio, 1.67; 95% confidence interval, 1.07-2.61; P = .024) and OS (hazard ratio, 2.31; 95% confidence interval, 1.22-4.40; P = .0106) in the post-RT pEBV-negative population, but not in the pEBV-positive population. CONCLUSIONS The current results prospectively validate pEBV as the most significant prognostic biomarker in NPC that can be used to select high-risk patients for adjuvant therapy. The ERCC1 C118T genotype may help to identify a favorable subgroup (approximately 7%) of pEBV-negative patients with NPC who have an excellent prognosis and can be spared the toxicities of further therapy.
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Affiliation(s)
- Edwin P Hui
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Brigette B Y Ma
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - K C Allen Chan
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles M L Chan
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Cesar S C Wong
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ka Fai To
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony W H Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Stewart Y Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Wai-Tong Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Ashley C Cheng
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Victor H F Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Stephen L Chan
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Herbert H F Loong
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Michael K M Kam
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Sing-Fai Leung
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Rosalie Ho
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Frankie Mo
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
| | - Roger K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anthony T C Chan
- Partner State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y.K. Pao Center for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
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Xuelei M, Jingwen H, Wei D, Hongyu Z, Jing Z, Changle S, Lei L. ERCC1 plays an important role in predicting survival outcomes and treatment response for patients with HNSCC: A meta-analysis. Oral Oncol 2015; 51:483-92. [DOI: 10.1016/j.oraloncology.2015.02.094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/03/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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Gao Y, Liu D. The roles of excision repair cross-complementation group1 in objective response after cisplatin-based concurrent chemoradiotherapy and survival in head and neck cancers: a systematic review and meta-analysis. Oral Oncol 2015; 51:570-7. [PMID: 25857670 DOI: 10.1016/j.oraloncology.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/14/2015] [Accepted: 03/20/2015] [Indexed: 12/26/2022]
Abstract
Our aim of the study was to investigate the precise relationship of repair cross-complementation group 1 (ERCC1) expression and the survival as well as objective response rate to cisplatin-based concurrent chemoradiotherapy (CCRT) and a meta-analysis was conducted to analysis ERCC1's prognostic roles in head and neck cancer. A search based on published articles in PubMed, Embase and CKNI database (up to Oct 15, 2014) to find eligible studies meeting eligibility criteria and then a meta-analysis was conducted to assess the outcomes in head and neck squamous cell carcinomas (HNSCC) patients with different ERCC1 expression. The principle outcomes were hazard ratio (HR) for survival analysis and relative risks (RR) for objective response. Fixed or random model was used for calculation according to the heterogeneity. The results showed that 9 studies involving 568 patients met the inclusion criteria. Low/negative expression of ERCC1 was associated with longer overall survival (OS) and profession-free survival (PFS) after receiving cisplatin-based CCRT therapy (HR 0.38; 95% confidence interval (CI) 0.21-0.63; P<0.001 and HR 0.37; 95%CI 0.21-0.63; P<0.001). And there was no significant difference discovered in objective response rate between low/negative and high/positive ERCC1 expression (RR 1.19; 95%CI 1.00-1.43; P=0.06). Evidence of modest heterogeneity was found between ERCC1 expression and OS (I(2)=48.8%, P<0.05) and subgroup analysis was performed based on ethnicity, variable methods and primary tumor location. The conclusion is that ERCC1 might be the one of adverse prognostic factors affecting the survival time and objective response to cisplatin-based chemoradiotherap due to its drug-resistance characteristics.
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Affiliation(s)
- Yang Gao
- Human Biology, University of Toronto, 300 Huron Street, Room 105, Toronto, Ontario M5S3J6, Canada
| | - Dong Liu
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan 250012, China; Key Laboratory of Otolaryngology, Ministry of Health, 44 West Wenhua Road, Jinan 250012, China.
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Quantitative methodology is critical for assessing DNA methylation and impacts on correlation with patient outcome. Clin Epigenetics 2014; 6:22. [PMID: 25859283 PMCID: PMC4391486 DOI: 10.1186/1868-7083-6-22] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/17/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND DNA hypermethylation is reported as a frequent event and prognostic marker in head and neck squamous cell carcinomas (HNSCC). Methylation has been commonly assessed with non-quantitative methodologies, such as methylation-specific PCR (MSP). We investigated previously reported hypermethylated genes with quantitative methodology in oral tongue squamous cell carcinomas (OTSCC). RESULTS The methylation status of 12 genes in 115 OTSCC samples was assessed by one or more of three quantitative analyses: methylation sensitive high resolution melting (MS-HRM), sensitive-melting analysis after real time-methylation specific PCR (SMART-MSP), and bisulfite pyrosequencing. In contrast to much of the literature, either no or infrequent locus-specific methylation was identified by MS-HRM for DAPK1, RASSF1A, MGMT, MLH1, APC, CDH1, CDH13, BRCA1, ERCC1, and ATM. The most frequently methylated loci were RUNX3 (18/108 methylated) and ABO (22/107 methylated). Interrogation of the Cancer Genome Atlas (TCGA) HNSCC cohort confirmed the frequency of significant methylation for the loci investigated. Heterogeneous methylation of RUNX3 (18/108) and ABO (22/107) detected by MS-HRM, conferred significantly worse survival (P = 0.01, and P = 0.03). However, following quantification of methylation levels using pyrosequencing, only four tumors had significant quantities (>15%) of RUNX3 methylation which correlated with a worse patient outcome (P <0.001), while the prognostic significance of ABO hypermethylation was lost. RUNX3 methylation was not prognostic for the TCGA cohort (P = 0.76). CONCLUSIONS We demonstrated the critical need for quantification of methylation levels and its impact on correlative analyses. In OTSCC, we found little evidence of significant or frequent hypermethylation of many loci reported to be commonly methylated. It is likely that previous reports have overestimated the frequency of significant methylation events as a consequence of the use of non-quantitative methodology.
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Chan OS, Ngan RK. Individualized treatment in stage IVC nasopharyngeal carcinoma. Oral Oncol 2014; 50:791-7. [DOI: 10.1016/j.oraloncology.2014.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/04/2014] [Accepted: 01/06/2014] [Indexed: 11/16/2022]
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Vassalou H, Stathopoulos E, Fiolitaki G, Koutsopoulos A, Voutsina A, Georgoulias V, Mavroudis D. Excision-repair-cross-complement-1 protein as a prognostic factor in patients with advanced non-small cell lung cancer treated with platinum-based first-line chemotherapy. Lung Cancer 2013; 82:324-9. [DOI: 10.1016/j.lungcan.2013.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/21/2013] [Accepted: 08/01/2013] [Indexed: 12/20/2022]
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Polymorphisms in ERCC1 C8092A predict progression-free survival in metastatic/recurrent nasopharyngeal carcinoma treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol 2013; 72:315-22. [PMID: 23712330 DOI: 10.1007/s00280-013-2196-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluated whether DNA repair gene polymorphisms had an effect on clinical outcomes in metastatic/recurrent nasopharyngeal carcinoma (NPC) patients treated with cisplatin-based chemotherapy. MATERIALS AND METHODS Clinical data of 101 patients with metastatic/recurrent NPC between 2004 and 2011 were reviewed. Five potentially functional polymorphisms (ERCC1 Asn118Asn, ERCC1 C8092A, XPD Lys751Gln, XRCC1 Arg399Gln and XRCC1 Arg280His) were genotyped using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. RESULTS The ERCC1 C8092A polymorphism was an independent predictor of PFS in Chinese NPC patients treated with cisplatin-based chemotherapy. Compared to the patients carrying the C/C genotype, the patients with the C/A or A/A genotype had an increased risk of disease progression on cisplatin-based chemotherapy (7.9 vs. 9.3 months; HR 1.61; 95 % CI 1.08-2.61; p = 0.047). However, no association between the other polymorphisms, response rate, disease progression and survival was detected in metastatic/recurrent NPC patients. CONCLUSION The ERCC1 C8092A polymorphism might be a useful predictive marker in metastatic/recurrent NPC patients treated with cisplatin-based chemotherapy. However, a large-scale prospective study is warranted to validate our findings.
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Jagdis A, Phan T, Klimowicz AC, Laskin JJ, Lau HY, Petrillo SK, Siever JE, Thomson TA, Magliocco AM, Hao D. Assessment of ERCC1 and XPF Protein Expression Using Quantitative Immunohistochemistry in Nasopharyngeal Carcinoma Patients Undergoing Curative Intent Treatment. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2012.09.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Krikelis D, Bobos M, Karayannopoulou G, Resiga L, Chrysafi S, Samantas E, Andreopoulos D, Vassiliou V, Ciuleanu E, Fountzilas G. Expression profiling of 21 biomolecules in locally advanced nasopharyngeal carcinomas of Caucasian patients. BMC Clin Pathol 2013; 13:1. [PMID: 23360534 PMCID: PMC3563444 DOI: 10.1186/1472-6890-13-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 01/24/2013] [Indexed: 12/28/2022] Open
Abstract
Background Since scarce data exist on the pathogenesis of nasopharyngeal carcinoma in Caucasian patients, we attempted to elucidate the responsible molecular pathways in this patient population. Methods Formalin-fixed paraffin-embedded tumor tissue samples from 107 patients, diagnosed with locally-advanced nasopharyngeal carcinoma and treated with chemotherapy or chemo-radiotherapy, were analyzed by immunohistochemistry for the expression of the following proteins: E-cadherin, P-cadherin, Fascin-1, Cyclin D1, COX-2, EGFR, VEGF-A, VEGF-C, VEGFR-2, VEGFR-3, ERCC1, p53, p63, Ki67, MAPT, phospho-p44/42MAPK, PTEN, phospho-AKT, phospho-mTOR, and phospho-GSK-3β. EBER status was assessed by in situ hybridization. The majority of the cases were included in tissue microarray. All stains were performed and assessed centrally by two pathologists. The median follow-up time was 76.8 (42.3 – 99.2) months. Results Biomolecules expressed in >90% of cases were: p53, COX-2, P-cadherin, EBER, phospho-GSK-3β, and Fascin-1. WHO II+III tumors were more frequently EBER & PTEN positive and VEGF-A negative. Advanced age was significantly associated with positive phospho-GSK-3β and ERCC1 expression; male gender with positive phospho-AKT and phospho-p44/42MAPK; and worse performance status (1 or 2) with negative Ki67, ERCC1, PTEN, and phospho-mTOR expression. Earlier disease stage was closely associated with p63, MAPT, PTEN, and Cyclin D1 positivity. Univariate Cox regression analysis highlighted Cyclin D1 as a negative prognostic factor for disease-free survival (p=0.034) and EBER as a positive one for overall survival (p=0.048). In multivariate analysis, advanced age and stage, poor performance status, and positive ERCC1 emerged as predictors of worse disease-free and overall survival, as opposed to positive phospho-mTOR. Clustering analysis defined two protein-expression groups being predictive of better overall survival (p=0.043). Conclusions Our study is the first to examine the activation and interaction of established biomolecules and signaling pathways in Caucasian NPC patients in an effort to reveal new therapeutic targets.
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Affiliation(s)
- Dimitrios Krikelis
- Department of Medical Oncology "Papageorgiou" Hospital, Aristotle University of Thessaloniki School of Medicine, Ring Road of Thessaloniki, Nea Efkarpia, Thessaloniki, PC, 56403, Greece
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Georgia Karayannopoulou
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Liliana Resiga
- Department of Pathology, "Ion Chiricuta" Cancer Institute, Cluj, Romania
| | - Sofia Chrysafi
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Epaminontas Samantas
- Third Department of Medical Oncology, "Agii Anargiri" Cancer Hospital, Athens, Greece
| | | | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Elisabeta Ciuleanu
- Department of Pathology, "Ion Chiricuta" Cancer Institute, Cluj, Romania
| | - George Fountzilas
- Department of Medical Oncology "Papageorgiou" Hospital, Aristotle University of Thessaloniki School of Medicine, Ring Road of Thessaloniki, Nea Efkarpia, Thessaloniki, PC, 56403, Greece
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Johung K, Rewari A, Wu H, Judson B, Contessa JN, Haffty BG, Decker RH. Role of excision repair cross-complementation 1 expression as a prognostic marker for response to radiotherapy in early-stage laryngeal cancer. Head Neck 2012; 35:852-7. [PMID: 22740347 DOI: 10.1002/hed.23041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND High expression of excision repair cross-complementation 1 (ERCC1) predicts for resistance to platinum-based chemotherapy or chemoradiotherapy. We evaluated the prognostic value of ERCC1 expression in a cohort of laryngeal cancer treated with radiotherapy alone. METHODS ERCC1 expression was examined by immunohistochemical analysis of tissue microarrays constructed from 123 patients with stages I-II laryngeal squamous cell carcinoma treated with standard radiotherapy. RESULTS ERCC1 expression did not correlate with clinicopathologic risk factors, local control, or overall survival. At 5 years, local control was 75% versus 71% (p = .78) and overall survival was 68% versus 54% (p = .65), for nonexpressors and expressors of ERCC1, respectively. On multivariate analysis, T classification predicted for local control, and T classification and age predicted for overall survival. CONCLUSIONS ERCC1 expression did not predict for radiotherapy resistance or worse survival. Therefore, radiotherapy remains an effective treatment in tumors with high ERCC1 expression.
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Affiliation(s)
- Kimberly Johung
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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Huang PY, Li Y, Mai HQ, Luo RZ, Cai YC, Zhang L. Expression of ERCC1 predicts clinical outcome in locoregionally advanced nasopharyngeal carcinoma treated with cisplatin-based induction chemotherapy. Oral Oncol 2012; 48:964-968. [PMID: 22571922 DOI: 10.1016/j.oraloncology.2012.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/13/2012] [Accepted: 04/05/2012] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to evaluate the correlation between excision repair cross-complementation group 1 (ERCC1) protein with the clinical outcome of nasopharyngeal carcinoma (NPC) patients treated with cisplatin-based induction chemotherapy. One hundred one Stage III-IVB nonkeratinizing NPC patients who were treated with cisplatin (DDP)+fluorouracil (5-Fu) induction chemotherapy were recruited. Pre-treatment tumor biopsy specimens were analyzed for ERCC1 by immunohistochemistry. The relationship of ERCC1 expression and chemotherapy response and survival of these NPC patients was analyzed. The objective response to induction chemotherapy of NPC patients with low ERCC1 expression compared with high ERCC1 expression was 88.2% vs. 72% (P=0.041). The 5-year distant failure-free survival (D-FFS) of NPC patients with low ERCC1 expression compared with high ERCC1 expression was 73.5% vs. 51.3% (P=0.037). ERCC1 expression was a significant prognostic factor for overall survival and D-FFS using Cox regression analysis. High tumor ERCC1 expression predicts low chemotherapy response and poor survival mainly caused by more metastasis in locoregionally advanced NPC treated with cisplatin-based induction chemotherapy.
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Affiliation(s)
- Pei-Yu Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Nasopharyngeal carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yan Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Nasopharyngeal carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Rong-Zhen Luo
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yu-Chen Cai
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
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The prognostic value of histological typing in nasopharyngeal carcinoma. Oral Oncol 2011; 48:429-33. [PMID: 22177891 DOI: 10.1016/j.oraloncology.2011.11.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 12/27/2022]
Abstract
We analyzed the relation of histological typing in late stage nasopharyngeal carcinoma (NPC) with clinical outcome and excision repair cross complementation group 1 protein (ERCC1) expression. The biopsy specimens of 259 patients with NPC were reviewed by two pathologists for classification according to 2005 WHO subtypes. The patients were of stage III to IVB and treated with radiotherapy (RT) alone or concurrent-adjuvant chemoradiotherapy (CRT). Expression of ERCC1 protein detected by immunohistochemistry on paraffin sections was correlated with the histological subtypes. There were 10 cases (3.9%) of differentiated non-keratinizing carcinoma compared with 249 cases of conventional undifferentiated carcinoma. The former exhibited more advanced squamous differentiation with 3 cases belonging to the papillary variant. The degree of ERCC1 expression was generally high compared with the median of the cohort. Clinically, the differentiated group fared poorly compared with the undifferentiated group with respect to loco-regional failure-free rate, distant failure-free rate, disease-free survival and overall survival (p≤0.05). Treatment modality of the 10 patients (5 RT, 5 CRT) was similar to the whole cohort. Contrary to general acceptance that differentiation of non-keratinizing NPC had little bearing on prognosis, we demonstrated that in endemic area differentiation in fact conferred a worse prognosis in stage III to IVB patients. There was positive correlation of differentiation with ERCC1 expression. We advocate precise histological typing of NPC in pathology report for prognostic purpose and outcome correlation.
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