EGFR cut-off point for prognostic impact in laryngeal squamous cell carcinoma

Abstract

Background: Various molecular biomarkers, including epidermal growth factor receptor (EGFR), have gained importance as predictors of head and neck cancer disease progression.

Aims: This study aimed to investigate the ability of EGFR expression as a prognostic marker for laryngeal squamous cell carcinoma (LSCC).

Materials and methods: A total of 31 patients with LSCC with immunohistochemistry (IHC) staining for EGFR were examined. Digital image processing was applied to analyze EGFR staining intensity and percent distribution, which were calculated as the H-score. We used a receiver operating characteristic (ROC) curve to identify the best cut-off point of EGFR expression, with H-score separated into high- and low-grade for cancer recurrence prediction.

Results: The cut-off point of EGFR expression for high- and low-grades was an H-score of 170 with a sensitivity of 75% and a specificity of 66.7%. Using this cut-off, 14 (45.16%) and 17 (54.84%) patients were categorized as having high- and low-grades EGFR, respectively. The analysis showed a significant reverse correlation between the EGFR grade and LSCC recurrence (RR, 0.4; 95% CI, 0.17–0.98; p?=?.02).

Conclusions: Our study demonstrated that EGFR grading using H-score with the generated cut-off point by the ROC curve might be further applied as a potential marker for LSCC prognostic prediction.     

Promoter hypermethylation of CCNA1, RARRES1, and HRASLS3 in nasopharyngeal carcinoma

In search for putative tumor suppressor genes critical of nasopharyngeal carcinoma (NPC), we analyzed the available information from the expression profiling in conjunction with the comprehensive alleotyping published data relevant to this malignancy. Integration of this information suggested eight potential candidate tumor suppressor genes, CCNA1, HRASLS3, RARRES1, CLMN, EML1, TSC22, LOH11CR2A and MCC. However, to confirm the above observations, we chose to investigate if promoter hypermethylation of these candidate genes would be one of the mechanisms responsible for the de-regulation of gene expression in NPC in addition to the loss of genetic materials. In this study, we detected consistent hypermethylation of the 5' element of CCNA1, RARRES1, and HRASLS in NPC tissues with prevalence of 48%, 51%, and 17%, respectively. Moreover, we found a similar profile of promoter hypermethylation in primary cultured NPC cells but none in normal nasopharyngeal epithelium or leukocytes, which further substantiate our hypothesis. Our data indicate that CCNA1, RARRES1, and HRASLS3 may be the putative tumor suppressor genes in NPC.     

Genomic alterations in nasopharyngeal carcinoma: loss of heterozygosity and Epstein-Barr virus infection.

Nasopharyngeal carcinoma is a subset of head and neck squamous cell cancers with unique endemic distribution and aetiological co-factors. Epstein-Barr virus has been revealed to be an important aetiological factor for most nasopharyngeal carcinomas. Nevertheless, additional genetic alterations may be involved in their development and progression. The aim of this study was to determine the likely chromosomal locations of tumour-suppressor genes related to Epstein-Barr virus-associated nasopharyngeal carcinoma. Fifty-six microsatellite polymorphic markers located on every autosomal arm were used to estimate the incidence of loss of heterozygosity in 27 Epstein-Barr virus-associated nasopharyngeal carcinomas. High frequencies of allelic loss were observed on chromosome 3p (75.0%) and 9p (87.0%). Chromosome 9q, 11q, 13q and 14q displayed loss in over 50%, while chromosome 3q, 6p, 16q, 19q and 22q exhibited loss in 35-50%. Furthermore, several other chromosomal arms demonstrated allelic loss in 20-35%. Additionally, 1 of the 27 cases showed microsatellite instability at multiple loci. These findings provide evidence of multiple genetic alterations during cancer development and clues for further studies of tumour-suppressor genes in Epstein-Barr virus-associated nasopharyngeal carcinoma.     

KTP laser inferior turbinoplasty: an alternative procedure to treat the nasal obstruction

OBJECTIVE: Nasal obstruction resulting from inferior turbinate hypertrophy (ITH) was treated with KTP laser inferior turbinoplasty (KIT). The effectiveness of the procedure was assessed. METHODS: A prospective clinical trial was carried out in King Chulalongkorn Memorial Hospital from October 1, 1998 to September 30, 2000. Forty-eight patients with chronic nasal obstruction underwent KIT. Nasal obstruction was pre- and postoperatively assessed, based on 4-point scale, by the patient and investigator. The scores were compared by paired t-test. The correlation of assessment by the patient and investigator was also demonstrated by weighted kappa test. Pre- and postoperative rhinomanometric evaluations were performed in 29 patients and were compared with paired t-test. RESULTS: Significant reduction of nasal obstruction was obtained from assessment by the patient (P<0.000) and by the investigator (P<0.000). The symptoms of sneezing, itching and rhinorrhea were significantly reduced postoperatively (P<0.000). The cure and improvement rate of nasal obstruction were at 70.8 and 100% (assessed by the patient) and at 77.1 and 100% (assessed by the investigator) respectively, and they showed a moderate correlation (Kw=0.65). Rhinomanometrically, the total airway resistance decreased but of not statistic significance (P=0.219), however, the inspired nasal airflow at 150 Pa and the volume of nasal cavities were significantly increased (P<0.00 and P<0.001, respectively). CONCLUSION: KIP was shown to effectively reduce the symptom and sign of nasal obstruction as well as other nasal symptoms without any significant complications. It should be an alternative method in treating the patients with nasal obstruction resulting from hyperplastic inferior turbinate.     

Telomerase assay and nested polymerase chain reaction from nasopharyngeal swabs for early noninvasive detection of nasopharyngeal carcinoma.

The main purpose of this study was to analyze sensitivity and specificity of combining nested polymerase chain reaction for detection of Epstein-Barr virus (EBV) genome and telomerase assay for identifying nasopharyngeal carcinoma (NPC). Eighty patients with NPC and 27 healthy control subjects were included in this study; 97. 5% and 94.9% of NPC patients were positive for EBV genome and telomerase activity, respectively. When nasopharyngeal swabs were tested, 95.7% presented the EBV genome and 85.5% were positive for telomerase expression. The sensitivity for counting either positive result of these two techniques was 100%. Among the 27 control subjects, only 6 and 5 cases were positive for EBV DNA and telomerase activity, respectively. This indicated a specificity of 92.6% when both positive results were included. At present, early diagnosis of NPC requires multiple biopsy specimens, especially to identify subclinical cases. Because this study showed a very high sensitivity for detecting NPC from swabs when combining the telomerase assay and nested polymerase chain reaction technique, this noninvasive technique may be a good candidate for screening of subclinical NPC, especially before multiple biopsy specimens are obtained.     

Auricular pseudocysts: a treatment with the Chulalongkorn University vacuum device.

Auricular pseudocysts are rare lesions that present as an asymptomatic cystic swelling of the anterior surface of the auricle, particularly the antihelix. Typically, the pseudocysts contain viscous straw-yellow fluid similar in appearance to olive oil; however, a clear pale yellow serous transudate may also be encountered. Various therapeutic approaches have been used with variable success. We describe a simple small vacuum device called the Chulalongkorn University vacuum device, which was developed in our center. The device can be easily made anywhere by any surgeon. We report the outcome in 17 patients treated by means of needle aspiration plus application of the Chulalongkorn University vacuum device for 5 days. A complete resolution of the lesion was obtained in 15 (88.2%) patients. Because the procedure is safe and effective and does not require an operating room setting, it may be accepted as an option in the treatment of auricular pseudocysts.     

Bile duct injuries during laparoscopic cholecystectomy: an audit of 1522 cases

BACKGROUND/AIMS: Bile duct injuries during laparoscopic cholecystectomy are serious complications. The incidence of this complication increases compared with open cholecystectomy. The aim of this paper has been to audit the incidence and nature of bile duct injuries during laparoscopic cholecystectomy in a single center. METHODOLOGY: From January 1991 to September 2000, all laparoscopic cholecystectomy attempts performed in Rajavithi Hospital were analyzed. RESULTS: Of the 1522 procedures performed, there were 9 (0.59%) cases of bile duct injuries. These involved the common hepatic duct (n=3) and the common bile duct (n=6). The underlying gallbladder pathology included chronic cholecystitis (n=6), Mirizzi's syndrome (n=2), and acute cholecystitis (n=1). Transection of the duct accounted for the majority of the injuries. Six bile duct injuries were identified at the time of operation. These were primarily repaired by direct suture (n=1) or by a biliary-enteric anastomosis (n=5). In the remaining three patients, the diagnosis was delayed. Two patients presented with a large amount of bile from the drain after surgery and one patient presented with jaundice. These were repaired by direct suture over a T tube (n=1) or biliary-enteric anastomosis (n=2). One patient developed recurrent cholangitis following biliary-enteric anastomosis after delayed diagnosis. CONCLUSIONS: The experience of a 0.59% incidence of bile duct injury is comparable to the best results from most large series in the West. Inflammation/adhesion at Calot's triangle is an important associated factor for injury. Injuries identified and repaired at the time of the first operation afford good results.