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Evaluation of the prognostic role of tumor cell podoplanin expression in locally advanced squamous cell carcinoma of the head and neck

Untersuchung der prognostischen Bedeutung der Tumorzellexpression von Podoplanin beim lokal fortgeschrittenen Plattenepithelkarzinom der Kopf-Hals-Region

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Abstract

Background and purpose

To investigate the potential prognostic role of tumor cell podoplanin expression in patients treated with resection followed by irradiation or chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN).

Materials and methods

Podoplanin expression (≤10 % versus > 10 %) and 12 other factors were evaluated in 160 patients for their association with locoregional control (LRC), metastases-free (MFS) and overall survival (OS). Other factors were age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, preradiotherapy (pre-RT) hemoglobin level, tumor site, histological grading, T category, N category, American Joint Committee on Cancer (AJCC) stage, human papillomavirus (HPV) status, extent of resection and concurrent chemotherapy.

Results

In multivariate analysis, ECOG performance status 0–1 (risk ratio, RR: 3.01; 95 % confidence interval, CI: 1.42–7.14; p = 0.003), pre-RT hemoglobin levels ≥ 7.45 mmol/l (12 g/dl; RR: 2.03; 95 % CI: 1.04–3.94; p = 0.038), oropharyngeal cancer (RR: 1.25; 95 % CI: 1.01–1.55; p = 0.038) and T category T1–2 (RR: 1.81; 95 % CI: 1.24–2.79; p = 0.002) were significantly associated with improved LRC. T category T1–2 (RR: 1.90; 95 % CI: 1.25–3.06; p = 0.002) and N category N0–2a (RR: 5.22; 95 % CI: 1.96–18.09; p < 0.001) were significantly associated with better MFS. Pre-RT hemoglobin levels ≥ 7.45 mmol/l (RR: 2.44; 95 % CI: 1.27–4.74; p = 0.007), T category T1–2 (RR: 1.97; 95 % CI: 1.36–3.04; p < 0.001) and N category N0–2a (RR: 2.87; 95 % CI: 1.37–6.61; p = 0.005) were significantly associated with improved OS. Podoplanin expression ≤ 10 % showed a trend towards improved OS on both univariate (p = 0.050) and multivariate analysis (RR: 1.86; 95 % CI: 0.96–3.59; p = 0.07).

Conclusion

Treatment outcomes were significantly associated with performance status, pre-RT hemoglobin level, tumor site and tumor stage. Tumor cell expression of podoplanin ≤ 10 % showed a trend towards improved OS when compared to podoplanin expression of > 10 %.

Zusammenfassung

Hintergrund und Ziel

Die mögliche prognostische Rolle der Tumorzellexpression von Podoplanin wurde bei Patienten mit lokal fortgeschrittenem Plattenepithelkarzinom der Kopf-Hals-Region (SCCHN) untersucht, die eine Resektion gefolgt von Strahlentherapie oder Radiochemotherapie erhalten hatten.

Material und Methoden

Die Podoplanin-Expression (≤10 % versus > 10 %) und 12 weitere Faktoren wurden bei 160 Patienten hinsichtlich ihres Einflusses auf die lokoregionale Kontrolle, das metastasenfreie Überleben und das Gesamtüberleben untersucht. Weitere Faktoren waren Alter, Geschlecht, Allgemeinzustand („Eastern Cooperative Oncology Group performance status“ [ECOG]), Hämoglobinwert vor Bestrahlung, Tumorlokalisation, histologisches Grading, T-Kategorie, N-Kategorie, AJCC-Stadium („American Joint Committee on Cancer“), HPV-Status (humaner Papillomavirus), Resektionsausmaß und simultane Chemotherapie.

Ergebnisse

In der multivariaten Analyse waren ein ECOG-PS 0–1 (Risk Ratio [RR] 3,01; 95%-Konfidenzintervall [KI] 1,42 – 7,14; p = 0,003), Hämoglobinwerte vor Bestrahlung ≥7,45 mmol/l (RR 2,03; 95%-KI 1,04 – 3,94; p = 0,038), Oropharynxkarzinome (RR 1,25; 95%-KI 1,01 – 1,55; p = 0,038) und eine T-Kategorie T1−2 (RR 1,81; 95%-KI 1,24 – 2,79; p = 0,002) signifikant einer besseren LRC assoziiert. Eine T-Kategorie T1–2 (RR 1,90; 95%-KI 1,25 – 3,06; p = 0,002) und eine N-Kategorie N0–2a (RR 5,22; 95%-KI 1,96 – 18,09; p < 0,001) waren signifikant mit einem besseren MFS assoziiert.

Schlussfolgerung

Die Behandlungsergebnisse waren signifikant mit dem Allgemeinzustand, dem Hämoglobinwert vor Bestrahlung, der Tumorlokalisation und dem Tumorstadium assoziiert. Eine Podoplanin-Expression ≤ 10% zeigte einen Trend für ein besseres OS, verglichen mit einer Podoplanin-Expression >10 %.

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Compliance with ethical guidelines

Conflict of interest. S. Huttenlocher, N.D. Seibold, M.P. Gebhard, F. Noack, C. Thorns, K. Hasselbacher, B. Wollenberg, S.E. Schild and D. Rades state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Stefan Huttenlocher, Nina D. Seibold & Dirk Rades M.D.

  2. Institute of Pathology, University of Lübeck, Lübeck, Germany

    Maximilian P. Gebhard, Frank Noack & Christoph Thorns

  3. Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany

    Katrin Hasselbacher & Barbara Wollenberg

  4. Department of Radiation Oncology, Mayo Clinic Scottsdalel, Phoenix, AZ, USA

    Steven E. Schild

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  1. Stefan Huttenlocher
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  4. Frank Noack
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  9. Dirk Rades M.D.
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Correspondence to Dirk Rades M.D..

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Huttenlocher, S., Seibold, N., Gebhard, M. et al. Evaluation of the prognostic role of tumor cell podoplanin expression in locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 190, 1021–1027 (2014). https://doi.org/10.1007/s00066-014-0694-1

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  • DOI: https://doi.org/10.1007/s00066-014-0694-1

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