Presence of activated T lymphocytes in peripheral blood of head and neck squamous cell carcinoma patients predicts impaired prognosis

CONCLUSIONS: The results indicate that a high level of peripheral blood (PB) T-lymphocyte activation in vivo predicts impaired prognosis with and without adjustment for TNM stage in head and neck squamous cell carcinoma (HNSCC). OBJECTIVE: To determine if PB T-lymphocyte activation in vivo is associated with the presence of, stage of and prognosis of HNSCC. MATERIALS AND METHODS: Sixty-two patients with newly diagnosed HNSCC and 15 control patients were studied. PB T-lymphocyte activation was assessed by measuring by flow cytometry the percentage of PB T lymphocytes (CD3 + ) showing the early activation-related cell surface epitopes CD69+ or CD71+ (transferrin receptor) or the late activation epitopes CD25+ (IL-2 receptor) or HLA-DR+. RESULTS: There was no significant difference in expression of T-lymphocyte activation markers between HNSCC patients and control patients, or any difference dependent on TNMG stage. In HNSCC patients a high percentage of CD71+ T lymphocytes predicted worse prognosis with a relative risk (RR) of 2.38 (confidence interval (CI): 1.04-5.47). A high mean value of the early (CD69 + /CD71 + ) (RR 2.37; CI: 1.06-5.29) or late (CD25 + /HLA-DR + ) (RR 3.31; CI: 1.39-7.88) activation markers also predicted worse prognosis. Following adjustment for TNM stage, high mean value of the early activation epitopes CD71+ (RR 2.89; CI: 1.22-6.85), the mean value of CD69 + /CD71+ (RR 2.58; CI: 1.12-5.91) and CD25 + /HLA-DR+ (RR 2.75; CI: 1.14-6.62) predicted worse prognosis.     

Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear.

Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC.

Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI.

Results: A total of 18 studies (n?=?3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88–4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92–3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86–3.63).

Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.     

The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome

Conclusion: HPV?+?HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can’t improve the Survival of the HPV-negative HNSCC patients.

Objective: To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

Methods: A search in PubMed and Chinese CNKI (2000–2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR).

Results: A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV?+?patients compared to HPV???patients (HR?=?0.48; 95% CI?=?0.37–0.62, p?p?p?p?p?= 0.05).     

M2-polarized tumour-associated macrophages in stroma correlate with poor prognosis and Epstein–Barr viral infection in nasopharyngeal carcinoma

Objectives: To assess the relationships between CD163 expression, localization of CD163⁺ macrophages, clinicopathological features and prognosis of NPC.

Methods: A total of 110 cases of NPC specimens and 80 cases of nasopharyngitis specimens were analysed for CD163 expression by immunohistochemistry and EBERs expression in situ hybridization.

Results: CD163?+?macrophages in the tumour stroma were positively correlated with the tumour and nodal stage. Higher expression of Epstein–Barr virus-encoded RNAs (EBERs) in the nuclei of tumour cells was associated with higher density of CD163?+?macrophages in the tumour stroma. More importantly, greater infiltration of CD163?+?macrophages in the tumour stroma was associated with poor overall survival (OS) and poor progression-free survival (PFS). Multivariate analysis revealed that the density of CD163⁺?macrophages in the tumour stroma may be an independent risk factor for NPC prognosis.

Conclusions: Increased infiltration of CD163⁺?macrophages in the tumour stroma correlates with worse outcomes and with Epstein–Barr virus (EBV) infection status of tumour cells in nasopharyngeal carcinoma (NPC).     

白细胞介素-2基因联合放疗对小鼠头颈鳞癌治疗作用的研究

目的：观察白细胞介素-2（IL-2）基因联合放疗对小鼠头颈鳞癌的抗肿瘤作用。方法：将25只小鼠平分为5组。利用SCCⅦ细胞株在C3H/HeJ小鼠口底建立头颈鳞癌荷瘤动物模型,IL-2组和联合组在荷瘤部位直接注射IL-2基因;EP组和对照组分别注射无目的基因的空载体和PBS,次日联合组与放疗组给予2Gy直线加速器的局部肿瘤放疗。4d后重复IL-2基因治疗,观察肿瘤治疗前后大小变化;检测肿瘤组织中CD4^ ,CD8^ 的表达,IL-2的分泌水平及自然杀伤细胞（NK）和细胞毒T淋巴细胞（CTL）的活性。结果：联合组肿瘤生长明显受抑制,疗效显著优于IL-2组,放疗组,EP组和对照组,IL-2组中,小鼠IL-2分泌水平明显升高,脾细胞NK活性和CTL杀伤活性增强,肿瘤组织内可见大片坏死,并含有大量的CD4^ ,CD2^ 淋巴细胞浸润,结论：IL-2基因治疗可提高肿瘤局部和全身的抗肿瘤免疫应答。能加强放疗的抗肿瘤效果。     

Value of extranodal extension detected by computed tomography for predicting clinical response after chemoradiotherapy in head and neck squamous cell cancer

Objectives: Radiological extranodal extension (rENE) upon CT is obtained before concurrent chemoradiation therapy (CCRT) for head and neck squamous cell carcinoma (HNSCC). We evaluated the prognostic value of rENE, rather than pathologically proven ENE, in patients who received CCRT for HNSCC.

Materials and methods: We reviewed 117 patients. We divided the patients into rENE(+) and rENE(?) groups and evaluated overall survival (OS) and disease-specific survival (DSS), and factors affecting these outcomes.

Results: Median follow-up was 37.4 months; 31 patients (26.2%) died and 26 (22.2%) had recurrence. Thirty patients were rENE(+) and these had worse 5-year OS (74% vs. 94%, p?p?n?=?87). rENE (hazard ratio [HR] 3.57, p?p?p?p?p?p?Conclusions: CT findings suggesting ENE predicts treatment response to CCRT and prognosis, and could be used to determine the treatment modality for HNSCC.     

人乳头状瘤病毒阳性的头颈鳞状细胞癌特异性基因生物信息学研究

目的分析人乳头状瘤病毒(HPV)阳性的头颈鳞状细胞癌(鳞癌)特异表达基因及关键信号通路,为HPV相关头颈鳞癌筛选有价值的基因标记物,并为进一步的肿瘤机制研究提供参考。方法从GEO高通量基因芯片数据库中筛选出头颈鳞癌具有HPV感染信息的芯片,从中筛出差异基因进行基因本体分析及京都基因和基因组(KEGG)信号通路富集分析,并筛出头颈鳞癌的特征基因簇和通路,以及关键基因并进行蛋白质相互作用网络可视化分析。通过Cbioportal信息门户以及癌症基因组图谱(TCGA)数据库验证这些特异基因在HPV(+)与HPV(-)头颈鳞癌中的表达差异并分析特异基因与头颈鳞癌患者生存预后的相关性。结果从数据集GSE52088与GSE39366中筛选出42个共同差异基因,其中上调基因25个,下调基因17个,经Cytoscape两轮筛选确定白介素-6(IL-6)、细胞表面标记物CD44、基质金属蛋白酶1(MMP1)、CXC趋化因子配体基序1(CXCL1) 4个特异基因。信号通路富集分析显示共同差异基因参与细胞周期、NOD样受体信号通路、肿瘤坏死因子(TNF)信号通路途径等信号通路(P < 0.01)。经TCGA数据库以及Cbioportal检验证实特异基因在HPV(+)与HPV(-)头颈鳞癌中的表达差异,且IL-6、CD44表达水平与头颈鳞癌生存预后呈负相关(P < 0.01)。结论HPV(+)头颈鳞癌具有特异性基因表达,并可能参与关键信号通路调控肿瘤的发生发展。IL-6、CD44、MMP1、CXCL1 4个特异基因可能参与HPV(+)头颈鳞癌发展及侵袭过程,其中MMP1、CXCL1有望作为诊断及预后的标志物,IL-6、CD44与头颈鳞癌预后存在相关性,有望成为治疗HPV(+)头颈鳞癌的潜在靶点。     

A systematic review of the role of mutant p53 in predicting outcome or response to treatment in head and neck squamous cell carcinoma (HNSCC).

Objectives. To systematically review whether the presence of mutant p53 alters patients’ prognosis in HNSCC. Method. Systematic searches of Medline, the Cochrane database of randomised controlled trials, Embase, review of conference abstracts and bibliographies of retrieved articles were performed. Studies were included if they; (1) considered biopsy proven primary HNSCC from the larynx, oropharynx, hypopharynx, or oral cavity. (2) Reported on the outcome following treatment that included radiotherapy, chemotherapy, surgery or a combination of these. (3) Attempted to assess p53 status and compared this with survival outcomes. (4) Measured survival outcomes at a minimum of 2 years post primary treatment. Primary outcome measures were overall survival (OS) and disease free survival (DFS). Hazard ratio (HR) with 95% confidence intervals (CI), was calculated from available data comparing outcome in mutant versus wild type p53 groups; initially for each study prior to aggregation. Results. 205 papers were fully scrutinised, of these 36 were suitable for meta‐analysis. Larynx: OS HR = 1.00 (95% CI 0.82–1.22); DFS HR = 1.27 (95% CI 0.99–1.63). Oral Cavity: OS HR = 1.50 (95% CI 1.15–1.95), DFS HR = 1.46 (95% CI 1.12–1.91). Oropharynx: OS HR = 1.26 (95% CI 0.92–1.73), DFS HR = 0.45 (95% CI 0.28–0.73). Hypopharynx: OS HR = 1.59 (95% CI 1.07–2.35), no papers had sufficient information from which DFS results could be calculated. Conclusions. The results suggest a survival benefit for the p53 negative group, however there is marked heterogeneity between these studies, so any final conclusion should remain guarded.     

Matched analysis of the prognosis of amelanotic and pigmented melanoma in head and neck

Abstract

Background: The prognosis of mucosal melanoma is poor, and the difference in clinical prognosis between patients with and without pigment needs further study.

Aim: To analyze data with head and neck mucosal melanoma, and compare the prognosis of patients with and without pigment.

Material and methods: The patients of amelanotic melanoma were matched with pigmented type according to age, sex, stage, location of disease, treatment history, tobacco and alcohol history. The Kaplan–Meier and Cox proportional risk regression model was used for analyzation.

Results: 46 patients of amelanotic melanoma and 46 of pigmented type were included in this study. The overall survival rate and progression-free survival rate of patients with pigmented melanoma were higher than in patients with amelanotic melanoma (HR = 0.533, p?=?.035, 95% CI = 0.296–0.957; HR = 0.530, p?=?.034, 95% CI = 0.294–0.953, respectively), and the risk of distant metastases in patients with amelanotic melanoma was significantly higher than that in patients with pigmented melanoma (HR = 0.474, p?=?.046, 95% CI = 0.228–0.987).

Conclusions and significance: The prognosis and disease-free survival of amelanotic melanoma is worse than for the pigmented type group. More identifying the differences in clinical characteristics will help to further individualized treatment decisions.     

Clopidogrel versus low‐dose aspirin as risk factors for epistaxis

Objectives: To quantify the relative risk of epistaxis for patients taking low‐dose aspirin or clopidogrel compared to patients taking neither drug. Design: Case‐control study. Setting: Primary care. Participants: 10,241 patients from three GP practices in the West Midlands. Main outcome measures: Epistaxis resulting in presentation to the GP, attendance at Accident & Emergency, or referral to ENT outpatients. Results: There was a significant difference in the proportion of patients with epistaxis across the three groups (χ² = 84.1; 2 degrees of freedom; P < 0.000001). Relative risk of epistaxis was increased in both the aspirin (RR = 9.04; 95% CI = 5.13–15.96) and clopidogrel (RR = 6.40; 95% CI = 2.33–17.56) groups compared to the no drug group. There was no increased risk of epistaxis with aspirin compared to clopidogrel (RR = 1.4; 95% CI = 0.6–3.4). Conclusion: There is an increased risk of troublesome epistaxis in patients taking aspirin or clopidogrel. There is no significant difference in risk of epistaxis between the two drug groups.     

Ectonucleotidase CD39 expression in regional metastases in head and neck cancer

Introduction: CD39 is the rate-limiting enzyme in the generation of immunosuppressive adenosine and its expression and activity are significant in tumor progression. Squamous cell carcinoma of the head and neck (HNSCC) shows an overall poor prognosis due to high local recurrence rates and early metastatic spread.

Material and methods: Primary tumor specimens and lymph node specimens harvested during neck dissection of 65 patients with a diagnosis of HNSCC were subjected to immunohistochemical and H-score analysis of CD39 expression. Demographics, histopathology and subsequent outcome were analyzed.

Results: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10). H-score for CD39 expression in the primary lesion and metastatic lymph nodes was significantly higher in advanced compared to early stages with no significant differences among different tumor locations. High intratumoral and intrametastatic CD39 expression was associated with an inferior patients’ overall survival at a mean follow-up of 83.4 months (6–204 months).

Conclusion: CD39 expression in HNSCC correlated positively with tumor stage and appears to predict poor prognosis. Therefore, CD39 expression in primary lesions and metastatic lymph nodes seems to identify patients at high risk in HNSCC of all tumor sites. Immunotherapeutic approaches targeting CD39 might be promising for this patient population.     

CD73 expression in lymph node metastases in patients with head and neck cancer

Introduction: CD73 is an enzyme crucial in the metabolism of immunosuppressive adenosine. In cancer, it has various functions including tumor growth and metastases. Squamous cell carcinoma of the head and neck has an overall poor prognosis, also due to early spread of metastatic cells.

Materials and methods: Tumor and lymph node specimens of 65 patients with HNSCC were subjected to immunohistochemical and H-score analysis of CD73 expression. Demographics, diagnoses, histopathology and subsequent outcome were analyzed.

Results: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10) with the following locations: oral cavity n:16, oropharynx n:28, hypopharynx n:11 and larynx n:10. H-score for CD73 expression in the primary lesion and metastatic lymph nodes was significantly higher in advanced compared to early stages with no significant differences among tumor locations. High CD73 expression was associated with reduced overall survival rates at a mean follow-up of 83.4 months (6–204 months).

Conclusions: CD73 expression in HNSCC correlated positively with tumor stage and was associated with poor prognosis. Therefore, CD73 expression in primary lesions and regional metastases appears to predict HNSCC patients at high risk of all tumor sites. Therapeutic approaches targeting CD73 might seem promising for this patient population.     

Prognostic significance of serum squamous cell carcinoma antigen in patients with head and neck cancer

Conclusions: Serum squamous cell carcinoma antigen (SCC-Ag) level was an independent prognostic factor for survival in patients with head and neck squamous cell carcinoma (HNSCC), and the prognostic value depended on the carcinoma site. Objectives: To assess the value of SCC-Ag as a prognostic indicator in patients with HNSCC and to determine the effect of primary tumor site on prognosis. Methods: We reviewed 493 patients with HNSCC between 2004 and 2012. The chi-squared test was used to assess associations between SCC-Ag levels and TNM classification. A Cox proportional hazard model was used to assess the hazard ratio of SCC-Ag at different sites for death, and it was analyzed as a continuous variable. Results: The median serum level of SCC-Ag was 1.1 ng/ml (range 0–20). SCC-Ag was significantly higher in patients with advanced T and N classification tumors. Primary sites in the oral cavity, in the hypopharynx, advanced T and N classification, distant metastasis, and SCC-Ag were negatively associated with survival in univariate analysis. Multivariate analysis revealed that SCC-Ag was a significant risk factor for overall survival in cancers of the oral cavity, hypopharynx, and larynx, but not in oropharyngeal cancer.     

Dendritic cells and lymphocyte subpopulations of the adenoid in the pathogenesis of otitis media with effusion

Objective

To assess dendritic cells and lymphocyte subpopulations of adenoid and peripheral blood in patients with adenoid hypertrophy and otitis media with effusion (OME). To explain the influence of immunological status of adenoid on the development of OME.

Methods

The examined group covered 123 surgically treated patients due to adenoid hypertrophy (39 children with coexisting OME). Preoperative clinical examination included anamnesis and otorhinolaryngological examination with nasofiberoscopy, videootoscopy and assessment of the hearing organ. The material of the study were surgically removed adenoids and peripheral blood samples prepared and then analyzed by the means of tri-colour flow cytometry. The obtained results were statistically analyzed.

Results

Significant differences between patients with adenoid hypertrophy with coexisting OME and children without OME concerning CD19+CD69+, CD3+CD69+, CD4+CD69+CD8+CD69+ and CD19+CD25+ cells were observed. No statistical differences were revealed in the blood of patients with and without OME. Several statistical differences were noted between the adenoid and peripheral blood in patients with otitis media with effusion concerning BDCA-2+/CD123+ cells, CD3+ and CD19+ lymphocytes with the markers of their activation.

Conclusions

The adenoid is involved in local immune response regardless of constitutional immunological mechanisms in patients with OME coexisting with adenoid hypertrophy. Significantly lower percentage of CD3+CD69+, CD4+CD69+, CD8+CD69+ and CD19+CD69+ cells of adenoid in patients with OME attests to reduced T-cells activation of the adenoid in relation to patients without OME.     

Combination nonviral murine interleukin 2 and interleukin 12 gene therapy and radiotherapy for head and neck squamous cell carcinoma

OBJECTIVES: To demonstrate that the combination of nonviral murine interleukin (mIL) 2 and mIL-12 gene therapy and external beam radiation therapy (XRT) have an enhanced therapeutic effect for the treatment of head and neck squamous cell carcinoma (HNSCC) in an orthotopic murine model and to elucidate the mechanism of action. DESIGN: A randomized, controlled study in a murine HNSCC model. INTERVENTIONS: Tumors were established in the floor of the mouth in C3H/HeJ immunocompetent mice with the SCC VII cell line. These tumors were directly injected with single lipid-formulated mIL-2 or single polymer-formulated mIL-12 or a combination of them and with phosphate-buffered saline or vector without mIL-2 and mIL-12 gene as controls. Then the local tumor was radiated twice with a dose of 1 Gy the next day and injected again 4 days later. Antitumor responses, cytokine expression, and natural killer cell and cytolytic T-lymphocyte activity were assayed. Meanwhile, tumor sizes were measured before and after treatment and compared among the different treatment groups and the controls. RESULTS: The combination mIL-2 + mIL-12 + XRT demonstrated a significant increase in antitumor effects compared with single therapy or controls. Increased expression levels of primary and secondary cytokines were found in the group treated with mIL-2 + mIL-12, and this effect was preserved when mIL-2 and mIL-12 treatments were combined with XRT. Combination therapy significantly increased antitumor effects, T-lymphocyte infiltration of CD4(+)and CD8(+), and the numerous necroses compared with monotherapy. CONCLUSIONS: Combination mIL-2 and mIL-12 gene therapy and XRT generates potent antitumor immune responses against HNSCC and significantly increases necrosis (apoptosis) in an orthotopic murine model of HNSCC. The nonviral mIL-2 and mIL-12 gene delivery system was well tolerated. Further optimization of treatment strategy for patients with HNSCC is warranted as well as consideration for human clinical trials.     

Immunological study on the expression of HLA-DR antigen in tonsillar epithelium]

Because of the efficacy of tonsillectomy, palmoplantar pustulosis (PPP) has been regarded as a tonsillar focal infection. The immune mechanism underlying focal infection has been considered to be one of the autoimmune diseases mediated mainly by immunoglobulins, but this remains to be clarified. The present study demonstrates the expression of HLA-DR antigen in tonsillar epithelium. An HLA-DR positive area in the epithelium was computed by an image-analyzing program, and evaluated by means of comparisons among hypertrophic tonsil, recurrent tonsillitis, and tonsils with PPP. HLA-DR antigen appeared at high intensities in hypertrophic tonsils and with PPP. The positive areas were mutually related to aging in hypertrophic tonsil and recurrent tonsillitis. Then, the infiltrating lymphocytes in tonsillar epithelium were counted and compared with the intensity of HLA-DR expression. A close correlation was found between the appearance of HLA-DR antigens and activation of infiltrating T-lymphocytes, but no clear relationship was found between HLA-DR antigen intensity and the number of B-lymphocytes. From these findings, it seemed that, in the tonsils with PPP, high HLA-DR intensity was observed in the epithelium and T-lymphocyte infiltration and activation were prominent. Moreover, the pustules on the soles of PPP patients were investigated. T lymphocytic infiltration was already observable in the upper dermis and epidermis in the early stage. Generally speaking, CD4 positive cells were present in substantially greater number than CD8 positive cells. Many CD25 positive cells were also observed around the basement membrane. But there were few cells adjacent to the pustules. These findings indicate that cellular immunity may influence the formation of pustules in the early stage.     

p53 codon 72 polymorphism association with head and neck squamous cell carcinoma

p53 tumoral suppressor gene harbors a functional polymorphism which codes either arginine (Arg) or proline (Pro) in the protein p53 of codon 72. Such polymorphism has been associated with the development or prognosis of head and neck squamous cell carcinoma (HNSCC).Aim: we assessed codon 72 p53 allelic frequencies and genotypes in HNSCC Iranian patients.Study design: Case Study.Materials and Methods: a total of 132 HNSCC patients and 123 healthy controls were genotyped. DNA source was from mononuclear cells of the peripheral blood. DNA amplification was done by means of the allele-specific polymerase chain reaction.Results: genotypes and allele distribution were not significantly different between patients and controls. Moreover, no statistically significant association was found between the 72 and p53 codon tumor location, gender or age at the time of diagnosis. However, the Pro/Pro genotype was significantly increase in stage IV patients (30.8%) when compared to stages I-III of the disease (11.1%) (p=0.03), and a significantly higher percentage of patients with the Pro allele had and a risk increase in stage IV disease (OR=2.2, 95% CI=1.2-4.2, p=0.01).Conclusion: data revealed that the p53 polymorphism do not impact the risk of HNSCC in Iranians, nonetheless, it can affect tumor progression to a higher tumor stage.     

Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis

Background: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. This study aimed to evaluate the effects of the Semont maneuver (SM) for BPPV treatment, compared with other methods.

Methods: Studies were selected in relevant databases under pre-defined criteria up to June 2015. The Cochrane evaluation system was used to assess the quality of the studies. Effect size was indicated as a risk-ratio (RR) with corresponding 95% confidential interval (CI). Statistical analysis was conducted under a randomized- or fixed-effects model. Sub-group analysis was performed.

Results: Ten studies were included in the meta-analysis. All of the studies presented a low attrition bias, but a high selection and reporting bias. SM had a much higher recovery rate (SM vs no treatment: RR?=?2.60, 95% CI?=?1.97–3.44, p?p?p?Conclusion: SM is as effective as EM and BDE for BPPV treatment.     

Personality traits in head and neck squamous cell carcinoma patients in relation to the disease state,disease extent and prognosis

OBJECTIVE: We aimed to study whether personality scores, as measured using the Eysenck Personality Inventory (EPI), are associated with the risk and prognosis of head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS: A total of 78 male patients with newly diagnosed HNSCC and 61 male patients with benign HN disease completed the EPI, which assesses the following: neuroticism, extraversion and lie score. The TNM stage, prognosis, diagnostic delay, level of education and smoking and alcohol consumption histories of the patients were also recorded. Patients with cachexia and those aged > 80 years were excluded. RESULTS: The cancer patients had higher neuroticism scores (10.7 +/- 0.5 vs 8.3 +/- 0.6; p < 0.01) than the control patients. This association was shown to be secondary to the fact that neuroticism is associated with increased alcohol consumption. The personality trait scores were not associated with the length of diagnostic delay. It was also suggested that a low lie score predicted disease-specific death in the HNSCC patients (p = 0.02). Total survival also seemed to be predictable (p < 0.05). CONCLUSION: Neuroticism is probably associated with a risk of HNSCC as a result of increased alcohol consumption. If the prognostic results can be replicated, a potentially important association between this personality trait and the prognosis of HNSCC is suggested.