gms | German Medical Science

84. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

08.05. - 12.05.2013, Nürnberg

Carcinoma of unknown primary in cervical lymph nodes shows striking similarities in the molecular profile with metastases from overt squamous cell carcinoma of head and neck but favourable prognosis despite advanced cervical stage

Meeting Abstract

  • corresponding author presenting/speaker Daniel Weiss - Hals-Nasen-Ohrenklinik, Universitätsklinikum Münster, Münster, Germany
  • author Thomas Heinkele - Hals-Nasen-Ohrenklinik, Universitätsklinikum Münster, Münster, Germany
  • author Mario Koopmann - Hals-Nasen-Ohrenklinik, Universitätsklinikum Münster, Münster, Germany
  • author Türker Basel - Hals-Nasen-Ohrenklinik, Universitätsklinikum Münster, Münster, Germany
  • author Eleftherios Savvas - Hals-Nasen-Ohrenklinik, Universitätsklinikum Münster, Münster, Germany
  • author Claudia Rudack - Hals-Nasen-Ohrenklinik, Universitätsklinikum Münster, Münster, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 84th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Nürnberg, 08.-12.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13hno09

doi: 10.3205/13hno09, urn:nbn:de:0183-13hno091

Veröffentlicht: 30. Juli 2013

© 2013 Weiss et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Carcinoma in cervical lymph nodes of unknown origin (cCUP) represents a rare clinical entity where optimal diagnostic and therapeutic management is still a widely debated issue. A broad consensus exists on the importance of primary detection and targeted therapy to minimize toxicity and maximize quality of life. Since the success rates of standard regimes for tracking site of origin, namely endoscopy of pharynx, larynx, trachea, bronchi and esophagus, blind biopsies of high-risk areas (tonsil, base of tongue and nasopharynx) and PET/CT still fail to be satisfactory molecular classification of cCUP is thus of utmost importance. The purpose is to gain a better insight into the molecular profile of cCUP in order to improve diagnostic and therapeutic procedures.

We analyzed the expression of 8 basic molecular parameters typically involved in HNSCC development, progression and early metastasis in tissue of metastases from 26 patients with HPV negative cCUP and 31 patients with overt and HPV negative primaries of oral cavity or pharynx through immunohistochemistry. Medical records were reviewed for age, sex, smoking and drinking behavior, extent of nodal involvement and distant metastasis, extracapsular spread (ECS), frequency of a secondary tumor and survival. Expression rates of different molecular parameters were correlated between each other within the entity (cCUP and metastases from overt HNSCC), between both entities, and in respect of the various clinical parameters mentioned above.

Evaluation of absolute expression levels showed no relevant differences between cCUP and metastases from overt primaries. Regarding the correlation of expression between the parameters within the given entities, we could find both, similarities and deviations between cCUP and metastases from overt primaries. In both entities, the expression of Ki-67 showed positive correlation with that of VEGFR (cCUP: p=0.002, σ=0.570; HNSCC: p=0.004, σ=0.515). In cCUP further significant relationships could be identified for Ki-67 and cytokeratin 5/6 (p=0.023, σ=–0.446), and EGFR and cytokeratin 5/6 (p=0.008, σ=0.512). In metastases from overt primaries we found relevant links between Ki-67 and EGFR (p=0.006, σ=0.490), MMP-2 and VEGFR (p=0.015, σ=-0.439), and MMP-2 and Ki-67 (p=0.018, σ=–0.423). Interestingly, patients with cCUP demonstrated improved progression-free survival (p=0.046) and overall survival (p=0.067) despite more advanced age (p=0.029), more advanced nodal stage (p=0.006) and higher incidence of ECS (p=0.045). In HNSCC, we could point out a higher expression of EGFR in samples from patients who developed a secondary tumor in the course of the disease (p=0.053) and samples from patients with ECS in associated metastases (p=0.035). By contrast, samples from patients with cCUP where ECS was missing showed significantly higher expression rates of MMP-2 (p=0.031).

We conclude that squamous cell carcinoma in cervical lymph nodes of unknown origin and metastases from overt primaries of the oral cavity or pharynx differ only slightly in terms of their molecular profile. Despite advanced stage often seen in this entity the respective patients can have acceptable outcome if treated radically.


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