Author: T. Cooper

Keratinization may be prognostic for patients with oropharyngeal squamous cell carcinoma, according to results of a retrospective, cross-sectional study.

The greatest prognostic value may be among patients who have p16-negative and nonbasaloid tumors, as well as those who are smokers, results showed. Keratinization may result histologically following hematoxylin-eosin staining that is associated with adverse outcomes in head and neck cancers, particularly oral cavity squamous cell carcinoma.

Hadi Seikaly, MD, FRCSC, professor of surgery and divisional director and zone section head for otolaryngology – head and neck surgery at the University of Alberta, and colleagues assessed the prognostic value of keratinization in a large cohort of patients. Subgroup analyses evaluated results based on p16 status, basaloid differentiation and smoking status.

The researchers used a prospectively collected database to identify 208 patients with oropharyngeal squamous cell carcinoma diagnosed and treated at a single tertiary cancer center between 2002 and 2009. The mean age of the patients was 58.4 years (range, 32-95 years), and the male-to-female ratio was 3.4 to 1.

The analysis included 146 smokers, 59 nonsmokers and three participants for whom smoking data were not available. Tissue microarrays were generated from each patient’s specimens stained with hematoxylin-eosin and immunohistochemical markers. Each image was scored for the presence of keratinization and/or basaloid differentiation, as well as p16 status.

Five-year disease-specific survival based on keratinization served as the primary outcome measure. Of the 208 samples, 112 were nonkeratinizing. The 96 patients with keratinizing samples were more likely to have advance-stage disease and be p16-negative.

The rate of 5-year disease-specific survival was significantly higher among those with nonkeratinizing tumors compared with those that were keratinized (63.3% vs. 44.8%; P=.007), the researchers said.

Results of subgroup analyses showed nonkeratinization was linked to better disease-specific survival among patients with p16-negative and nonbasaloid tumors, as well as among those who were smokers.

Patients who smoked and had p16-negative keratinizing tumors demonstrated the lowest rate of 5-year disease-specific survival (26.7%) among any subgroup.

One of the researchers reported an unpaid consultant role with and travel reimbursement from AstraZeneca.

Cooper T. JAMA Otolaryngol Head Neck Surg. 2015;doi:10.1001/jamaoto.2014.3335

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