"Molecular margins": a better measure?

Research Progress Regarding Surgical Margins, Molecular Margins, and Prognosis of Laryngeal Carcinoma

BACKGROUND

Laryngeal carcinoma is one of the most common malignant tumors of the head and neck. Researchers have refined the study of surgical margin in the anatomical subarea of the larynx to determine the most appropriate distance of the surgical margin for laryngeal carcinoma, to achieve accurate resection of laryngeal carcinoma and to improve the possibility of retention of laryngeal function.

METHODS

A comprehensive review of the primary literature was performed from 2009 to 2019 utilizing keywords laryngeal carcinoma, surgical margin, molecular margin, and prognostic factor. Articles were included at the discretion of the authors based on novel and/or contributions to the literature.

RESULTS

The prognosis of laryngeal carcinoma significantly correlates with the status of surgical margins. Patients with positive surgical margins have higher recurrence and metastasis rates and worse prognosis. Patients with negative pathological surgical margin but with the expression or altered expression levels of one or more tumor-related molecular biomarkers had high rates of recurrence and metastasis, and poor prognosis.

CONCLUSIONS

Clinical intervention can improve the prognosis of patients with positive surgical margins. Patients with close margins should be followed closely. Among patients with negative surgical margins, patients with abnormal molecular margin results should be closely followed up. However, the specific selection of one or several molecular biomarkers as the detection index of molecular margin currently requires multicenter prospective or retrospective large sample study as guidance.

An ssDNA aptamer selected by Cell-SELEX for the targeted imaging of poorly differentiated gastric cancer tissue

Gastric cancer (GC) is associated with high morbidity and mortality rates worldwide. Poorly differentiated GC predicts a poor prognosis and is related to patients' response to chemotherapy and targeted therapy. Therefore, it is very important to accurately evaluate the tumour differentiation status for the treatment of poorly differentiated GC. To develop a molecular probe to analyse poorly differentiated GC, we selected aptamers against poorly differentiated GC by subtractive Cell-SELEX using the poorly differentiated GC cell line BGC-823 as the target and the moderately differentiated GC cell line SGC-7901 as the negative control. After 15 rounds of selection, aptamer PDGC21 exhibited the highest affinity, and the K_d value of the truncated aptamer PDGC21-T was 35.2 ± 1.1 nM. Aptamer PDGC21-T not only specifically bound to the target cells but also bound to other poorly differentiated GC cells. When combined with fluorescent nanoparticle quantum dots (QDs), the PDGC21-T-QD probe could distinguish poorly differentiated GC cells in mixed culture cells and clinical specimens. Furthermore, in a tissue microarray containing 15 cases from patients, there was a higher positive rate in GC tissues compared with adjacent normal tissues; in poorly differentiated tissues, in particular, the fluorescence signal was significantly higher than that in well/moderately differentiated tissues. Therefore, aptamer PDGC21-T holds great potential for use as a molecular imaging probe for the detection of poorly differentiated GC, which is of great significance for diagnosis and treatment.

Expression of eukaryotic initiation factor 4 E in hypopharyngeal carcinoma

OBJECTIVES

To investigate the expression of eukaryotic initiation factor 4 E (eIF4E) in hypopharyngeal carcinoma compared with benign lesions, and the relationships between eIF4E expression and various clinicopathological parameters.

METHODS

Expression of eIF4E was analysed retrospectively in specimens from hypopharyngeal carcinomas and benign hypopharyngeal lesions using immunohistochemical staining and Western blotting. Tumours were classified using the tumour-node-metastasis staging system and the degree of histological differentiation was assessed.

RESULTS

A total of 55 hypopharyngeal carcinoma and 20 benign specimens were analysed. All the hypopharyngeal carcinoma samples were positive for eIF4E expression on immunohistochemistry, whereas the benign lesions were negative or weakly positive. Semi-quantitative assessment (eIF4E score) showed that eIF4E expression was significatly higher in hypopharyngeal carcinoma than in benign lesions. On Western blotting, eIF4E expression assessed using integrated optical density (IOD) was significantly higher in hypopharyngeal carcinoma than in benign lesions. The eIF4E score and IOD value were significantly associated with tumour stage, lymphatic metastasis and degree of differentiation. The IOD value was significantly higher in recurrent compared with initial cases.

CONCLUSIONS

eIF4E may play an important role in the development and metastasis of hypopharyngeal carcinoma;its expression may be helpful in establishing the diagnosis, stage and prognosis of this tumour type.

The prognostic value of p53 expression in negative surgical margins of early glottic carcinoma in the prediction of local recurrences

CONCLUSIONS

p53 overexpression (>5%) in the surgical margins was more valuable than in the primary tumor tissue for the prediction of local recurrence among surgically treated early glottic cancers. This is the first study to compare p53 values in both primary tumor and surgical margin tissues of the same patients with early glottic cancers.

OBJECTIVE

To assess the prognostic value of p53 expression in the surgical margins of early glottic cancers treated with external laryngeal surgery in the prediction of local recurrences.

METHODS

Fifteen patients with early glottic cancer with local recurrences (group 1) and 15 without any recurrences (group 2) were included in the study. p53 expression was determined in both the tumor and the tumor-negative surgical margins.

RESULTS

Median p53 in the primary tumor was 55% (interquartile range (IQR) = 67) and 5% (IQR = 71) in groups 1 and 2, respectively (p = 0.178). Median p53 in the surgical margin was 11% (IQR = 13) and 2% (IQR = 2) in groups 1 and 2, respectively (p = 0.001). In the logistic regression analysis only surgical margin p53 value was significant in the prediction of recurrences (odds ratio (OR) = 1.68, 95% CI = 1.1-2.6, p = 0.017). Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve was 0.86 (p = 0.002) and 0.65 (p = 0.180) in the surgical margin and the primary tumor, respectively.

The role of molecular margins as prognostic factors in laryngeal carcinoma in Chinese patients

CONCLUSION

Molecular margins were a more important prognostic factor in laryngeal carcinoma in Chinese patients than histopathological margins. eIF4E was the most sensitive molecular index of those that we tested for in these patients.

OBJECTIVES

Safe surgical margins are closely related to prognosis. The aim of the present study was to investigate the role of molecular margins, not traditional histopathological margins, as prognostic factors in laryngeal carcinoma in Chinese patients. An additional aim of the study was to investigate the prognostic significance of tumor markers in the primary site of laryngeal carcinoma.

METHODS

From January 1992 to January 2000, the data for 321 Chinese patients with laryngeal carcinoma who were divided into a recurrent laryngeal carcinoma group and a non-recurrent group were analyzed. Tumor markers in surgical margins and primary site, such as cyclin D1, p53, and eIF4E, were detected in the two groups with immunohistochemical staining.

RESULTS

There was a significant difference in the expression of cyclin D1, p53, and eIF4E in surgical margins between the recurrent laryngeal carcinoma group and the non-recurrent group. The eIF4E-positive rate in surgical margins was higher than that for the other two factors. There was a significant difference in cyclin D1 and p53 in the primary site of laryngeal carcinoma and no significant difference in eIF4E in the two groups.

The expression of proto-oncogene eIF4E in laryngeal squamous cell carcinoma

OBJECTIVES/HYPOTHESIS

The translation initiation factor eukaryotic initiation factor 4E (eIF4E) binds to the cap of messenger RNA in the first step of messenger RNA recruitment. Overexpression of eIF4E results in the upregulation of specific angiogenic factor basic fibroblast growth factor (bFGF). The study aims to demonstrate that the overexpression of eIF4E could facilitate recognizing initiation start sites for the translation of bFGF and play an important role in the tumorigenesis of laryngeal squamous cell carcinoma.

STUDY DESIGN

Retrospective.

METHODS

Paraffin-embedded sections of 37 samples of laryngeal squamous cell carcinoma, 10 samples of vocal cords polyps, and 20 fresh samples of laryngeal squamous cell carcinoma were analyzed using immunohistochemical streptavidin peroxidase technique, Western blot analysis, and reverse transcriptase-polymerase chain reaction.

RESULTS

The overexpression of eIF4E was observed in all 37 paraffin-embedded samples of laryngeal squamous cell carcinoma, whereas no staining was noticed in vocal cords polyps samples. There were significant correlations between the overexpression of protein eIF4E and TN stages, histological grades, local recurrence, and the states of metastasis (P <.01). Moreover, the overexpressions of both bFGF protein and bFGF messenger RNA correlated with the histological grades and the states of metastasis (P <.01), but the overexpression of eIF4E and bFGF did not correlate with age, sex, and tumor sites (P >.05).

CONCLUSIONS

Eukaryotic initiation factor 4E can enhance the expression of bFGF at translation level. The eIF4E and bFGF collaborate in tumorigenesis, development, invasion, and metastasis of laryngeal squamous cell carcinoma, in view of which the former can be considered as a tumor molecular marker and an independent prognostic molecular marker of laryngeal squamous cell carcinoma.

Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery

OBJECTIVES

Intraoperative frozen section analysis of surgical margins is widely used in head and neck cancer surgery. This study evaluates frozen section accuracy relative to permanent controls and final margins from the entire specimen, the rate at which frozen sections impact intraoperative management, and the resultant cost.

STUDY DESIGN

Retrospective.

METHODS

From 1997 to 1999 the frozen section results, permanent controls, and final tumor margins from 80 consecutive patients undergoing 420 intraoperative frozen section margins for head and neck malignancy were reviewed.

RESULTS

A 98.3% accuracy rate (sensitivity, 88.8%; specificity, 98.9%) was found compared with permanent sections of the same tissue. However, 40% (8 of 20) of patients with positive final margins on the resection specimen, and 100% (15 of 15) with close (<5 mm) margins were not detected by frozen section analysis. The overall accuracy of frozen section in the evaluation of close or positive final margins was 71.3% (sensitivity, 34.3%; specificity, 100%). In addition, 5% (4 of 80) of patients potentially benefited from intraoperative frozen section by virtue of immediate margin revision. The estimated cost of intraoperative frozen section averaged as much as $3,123 per patient, with a cost-benefit ratio of 20:1.

CONCLUSIONS

Intraoperative frozen section margins are accurate, but they are costly and cannot reliably eradicate positive final margins. Patients with early-stage lesions and those undergoing re-resection for recurrence or salvage surgery after radiation failure derived the greatest potential benefit from frozen section margins.