Prognostic significance of keratinization in nasopharyngeal carcinoma

Reddy, Sarada P.; Raslan, Wasim F.; Gooneratne, Sorojini; Kathuria, Satinder; Marks, Joe

doi:10.1016/0196-0709(95)90040-3

Cited by 139 publications

(98 citation statements)

References 20 publications

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“…There is a high incidence of distant metastases with nonkeratinising or undifferentiated NPC, as compared to other epidermoid carcinoma arising in the head and neck region (Reddy et al, 1995). This is especially true for patients who present with locally advanced disease (Ahmad and Stefani, 1986).…”

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confidence: 99%

Validation of a new prognostic index score for disseminated nasopharyngeal carcinoma

Toh

Heng

et al. 2005

Br J Cancer

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Patients with metastatic nasopharyngeal carcinoma have variable survival outcomes. We previously designed a scoring system to better prognosticate these patients. Here, we report results on validation of this new prognostic index score in a separate cohort of patients. Clinical features and laboratory parameters were examined in 172 patients with univariate and multivariate analyses and a numerical score was derived for each independent prognostic variable. Significant independent prognostic variables and their scores assigned included poor performance status (score 5), haemoglobin o12 g dl À1 (score 4) and disease-free interval (DFI) (DFIp6 months (score 10) or metastases at initial diagnosis (score 1)). Maximum score was 19 and patients stratified into three prognostic groups: good, 0 -3; intermediate, 4 -8; poor, X9. When applied to a separate cohort of 120 patients, 59 patients were good, 43 intermediate and 18 poor prognosis, with median survivals of 19.6 (95% CI 16.1, 23.1), 14.3 (95% CI 12.3, 16.2) and 7.9 (95% CI 6.6, 9.2) months, respectively. (logrank test: P ¼ 0.003). We have validated a new prognostic score with factors readily available in the clinics. This simple score will prove useful as a method to prognosticate and stratify patients as well as to promote consistent reporting among clinical trials.

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confidence: 99%

Validation of a new prognostic index score for disseminated nasopharyngeal carcinoma

Toh

Heng

et al. 2005

Br J Cancer

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“…The histologic type was another factor affecting the prognosis of our NPC patients. Unlike other types of cancer, however, patients with poorly differentiated or undifferentiated NPC have a favorable prognosis compared to those with moderately or well-differentiated NPCs in previous studies 28,29) and our present NPC series. This is an interesting finding.…”

Section: Discussionmentioning

confidence: 59%

Site‐specific Localization of Epstein‐Barr Virus in Pharyngeal Carcinomas

Kojya¹,

Itokazu²,

Noda³

et al. 1998

Japanese Journal of Cancer Research

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In this study, the correlations of factors with Epstein-Barr virus (EBV)-association were investigated in 50 patients with nasopharyngeal carcinoma (NPC), 61 with oropharyngeal carcinoma (OPC), and 55 with hypopharyngeal carcinoma (HPC) in Okinawa and Osaka prefectures in Japan. The incidence of pharyngeal carcinoma in Okinawa was previously found to be higher than that in Osaka; the incidence of OPC was approximately 6 times higher and that of HPC was two times higher. The EBV genome was detected in the tumor cells of the present patients; 83% of the Okinawa and 92% of the Osaka NPC patients. The EBV genome was not detected in OPC or HPC. A univariate analysis showed that sex, the location of the tumor, histology, and the degree of lymphocytic infiltration correlated with the EBV-positive rate. A multivariate analysis revealed that only the location of the tumor was independently correlated with the EBV-positive rate. Histology and tumor size were factors affecting the prognosis of the patients with NPC. The NPC of poorly differentiated type frequently showed the EBV genome, and NPC with lymphocytic infiltration showed a more favorable prognosis compared to the other NPC types. These findings suggest that latent genes of EBV expressed in cancer cells might trigger a cytotoxic T cell reaction against the cancer. Key words: Epstein-Barr virus -Pharyngeal carcinoma -EpidemiologyEpstein-Barr virus (EBV), a herpesvirus which can infect lymphocytes, was originally discovered in cultured lymphoblasts from the African type of Burkitt's lymphoma in 1964.1) An oncogenic role of EBV in the development of B cell lymphoma and nasopharyngeal carcinoma (NPC) was subsequently suggested.2) Recent studies have shown the presence of EBV sequences in carcinoma cells of thymic, 3) gastric, 4) salivary gland, 5,6) and lung cancers. 7)The pharyngeal space is divided into three parts; the nasopharynx, oropharynx, and hypopharynx. The nasopharynx is covered with pseudostratified respiratory epithelium, and the oropharynx and hypopharynx are covered with stratified squamous epithelium. The naso-and oropharynxes have well-developed lymphoid tissue, i.e., Waldeyer's ring, whereas the hypopharynx is devoid of lymphoid tissue. The association of EBV with NPC is well-known, and it has been reported that EBV-associated NPC usually have poorly differentiated morphology accompanied by severe lymphoid cell infiltration, forming a lymphoepitheliomatous lesion. It is not yet evident whether oropharyngeal and hypopharyngeal carcinomas (OPC and HPC), especially those of the poorly differentiated type, are EBV-associated.We recently reported a much higher frequency of sinonasal lymphoma in Okinawa prefecture compared to Osaka in Japan, and we showed that the majority of these lymphomas were associated with EBV.8) The incidence of pharyngeal carcinoma in Okinawa was also found to be higher than that in Osaka; the incidence of OPC is approximately 6 times higher and that of HPC is two times higher in Okinawa. 9) In the present study, we investigated wh...

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“…A dose of 70 to 75 Gray units is administered to most patients over a period of 7 to 8 weeks to the primary tumor and regional lymph nodes. Both WHO Type 2 and 3 NPCs are generally more radiosensitive and have a higher local control rate after radiotherapy than WHO Type 1, but they are also more likely to undergo distant metastasis (Reddy et al, 1995). Although NPC has remarkable radiosensitivity and chemosensitivity at the early stages of treatment due to p53 functionality and retention of clonality, there is usually resistance to these treatment modalities in more advanced stages of NPC.…”

Section: Treatmentmentioning

confidence: 99%