Prognostic Factors of Head and Neck Squamous Cell Carcinoma

Information on reliable factors to predict patient outcome is important for deciding upon the best treatment to increase loco-regional control, overall survival and quality of life of patients with head and neck squamous cell carcinoma (HNSCC). Objective: To investigate the prognostic significance of clinicopathological factors including the finding of disseminated tumour cells by K5 mRNA RT-PCR in a population of 50 patients with HNSCC. Methods: Univariate and multivariate analysis using Cox's regression model was used to identify any significant associations between the finding of disseminated tumour cells in blood detected by RT-PCR for K5 mRNA and other clinical and pathological features with disease recurrence and survival. Results: Univariate analysis showed that age (p=0.008), clinical TNM stage (p=0.02), clinical T stage (p=0.009) and positive tumour margin (p=0.002) predicted the risk of the development of disease recurrence by but not the finding of disseminated tumour cells in blood of patients with HNSCC taken before treatment, peroperatively or after treatment (p=0.7). Some predictors for worse survival were perineural invasion (p=0.008), positive surgical margin (p=0.04) and the finding of disseminated tumour cells in blood by RT-PCR for K5 mRNA taken (a) before treatment (p=0.02), (b) combined finding: before treatment and preoperatively (p=0.04) and it was marginally associated with (c) combined finding: before treatment, peroperatively and after treatment (p=0.05). Conclusion: In agreement with other studies, this study found that some traditional factors influenced disease recurrence and overall survival. Interestingly, a positive blood result assessed by RT-PCR for K5 mRNA was independently associated with worse overall survival. A longer term follow-up is required for patients with positive K5 mRNA in their blood this group of patients as well as examination of further blood samples from patients who have positive blood only at after treatment blood examination because of the possibility of temporary tumour dormancy.