The current LDL-C target <1.4mmol/l of the ESC is achieved in less than 16% of patients with Coronary Heart Disease despite effective lipid-lowering therapy: data from the LLT-R registry

Background

In the current guideline of the ESC, in patients with very high cardiovascular risk such as coronary heart disease (CHD) a treatment target for LDL-C <1.4mmol/l and/or a halving of the initial value are defined. It is unclear whether these treatment targets are achievable with standard therapy including statins and/or ezetemibe.

Methods

The primary objective of this prospective, multi-centre register study was the question of the guidance-based adaptation and adherence to lipid-lowering therapy during and after a cardiac rehabilitation in 1,100 patients with CHD up to 12 months after discharge from the six rehabilitation clinics involved. Patients were included from 2016 to 2018.

Results

The median age of the 1,100 patients was 63.4±10.4 years, the mean BMI was 28.5±4.7kg/m2, and 24.1% of patients were female. 12.2% were active smokers, 91.6% reported dyslipoproteinemia, 33.9% suffered from diabetes mellitus and 86.5% from hypertension.

The majority of patients were included with the main indications NSTEMI (31.6%), STEMI (29.6%) and after CABG surgery (26.4%).

The proportion of patients treated with statins was more than 94% when admitted and discharged from the rehabilitation clinic, as well as in 3- and 12-months follow-ups.

Approximately 9% of patients were treated with ezetemibe at baseline. On discharge from the rehabilitation clinic 23% of patients were treated with ezetemibe, which remains stable at 3 and 12 months.

PCSK9 inhibitors were used in 0.1–0.3% of patients at all times.

The adjustment of LLT during three week cardiac rehabilitation resulted in median LDL-C values of 2.27mmol/l (1.80/2.84) at baseline, 1.97mmol/l (1.57/2.47) on discharge (p<0.001 compared to baseline), 1.94mmol/l (1.57/2.49) after three months and 1.94mmol/l (1.53/2.40) after 12 months.

The proportion of patients with LDL-C <1.4mmol/l was 9% at baseline, 15.7% on discharge (p<0.001 compared to baseline), 15.6% at three-month follow-up and 15.1% at 12-month follow-up (Figure 1).

Discussion

In the context of cardiac rehabilitation, an effective adjustment of LLT is carried out, which resulted in a significant reduction of LDL-C. However, despite a high percentage of patients on statins and ezetemibe, the proportion of patients in the new target range <1.4mmol/l was only achievable in a small percentage and the question arises whether these treatment targets can be achieved without additional administration of PCSK9 inhibitors in majority of patients with CHD.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): This study was supported by an unrestricted grant from Sanofi-Aventis Germany.

A New Approach to Phenotyping Disseminated Tumor Cells: Methodological advances and Clinical Implications

At the time of primary therapy (surgery, systemic chemotherapy and/or radiation), disseminated tumor cells in the bone marrow can be found in almost one-third of patients with cancer of the breast, ovary, esophagus, stomach, colon, and other solid tumors. Whereas the prognostic impact of the mere presence of these cells is still a matter of debate, it has been shown that expression of tumor-associated antigens in disseminated tumor cells is linked to more aggressive disease. Therefore, further characterization of disseminated tumor cells at the protein and gene level has become increasingly important. To date, the most common detection method for disseminated tumor cells in the bone marrow is an immunocytochemical approach using cytokeratin-directed antibodies for detection of epithelial cells and the APAAP system for their visualization. We have established a new double immunofluorescence technique enabling simultaneous detection, phenotyping, and antigen quantification of disseminated tumor cells. Mononuclear cells from bone marrow are enriched by Ficoll gradient centrifugation and cytospins are prepared. Double immunofluorescence is performed using antibodies against cytokeratins 8/18/19 (mAb A45B/B3) and the uPA receptor CD87 (pAb HU277). CD87 expression is recorded by confocal laser scanning microscopy (CLSM) using fluorescence labeled latex beads as the reference; staining intensities of all the scans are then summed and quantified (extended focus). This protocol, originally designed for disseminated tumor cells in bone marrow, can also be applied to disseminated tumor cells in blood, to leukapheresis cells or to cells present in malignant ascites or other malignant effusions. The tumor cells detected may be used for gene and mRNA analyses. Furthermore, disseminated tumor cells also represent interesting targets for clinical studies on patient prognosis or prediction of therapy response as well as for specific tumor-biological therapies.

Preoperative assessment of relative pulmonary lobar perfusion fraction in lung cancer patients

Preoperative quantification of (relative) pulmonary lobar perfusion fraction using scintigraphy is established in predicting lung function after pulmonary surgery. Aim was to develop an easy and truly anatomical method for relative pulmonary lobar perfusion fraction quantification using SPECT/CT and to compare results with those from planar analyses in lung cancer patients. Patients, methods: 36 patients with operable lung cancer, borderline lung function referred to pre-operative quantification. Perfusion SPECT-data were acquired p.i. of 163±9 MBq 99mTc-MAA, subsequent low-dose-CT (SymbiaT, Siemens). Iterative Flash3D-reconstruction, manual 3D segmentation of all lobes using PMOD. VOI transfer to coregistered perfusion SPECTdata, calculation of lobar fractions. Modelbased calculation of relative lobar fractions based on planar data, analysis of planar vs. 3D results using t-test. Results: Significant differences (p<0.05) between the results from 3D method and planar imaging were found for right upper and middle lobe and both lower lobes. Maximum differences ranged from 10.9% (left upper lobe) to 22.9% (right upper lobe). Conclusions: Relative pulmonary lobar perfusion fraction can easily be obtained by an anatomically driven 3D quantification. Results yielded by this method and the traditional planar approach differed greatly, possibly affecting eligibility for lung surgery in individual patients. Considering these results a 3D approach should be used whenever possible.

[How Valid is the Performance Diagnostic in Soccer?]

BACKGROUND

Assessments of physical and physiological performance tests in soccer sports are still unspecific yet. There is also a lack of scientific validation using those as a "golden standard". Concerning match performance a large deficit also exist in sports and medical science.

OBJECTIVE

The aim and purpose of this multicentric and prospective diagnostic study was to evaluate the validity of current established and recommended diagnostic tests for endurance and match performance (golden standard: real time of playing) in soccer.

MATERIALS AND METHODS

In a prospective study protocol two German soccer teams from the fourth (n = 22) and third (n = 24) national league first underwent different tests of performance and diagnostics ahead of the competition season (tapping, drop jump, counter movement jump, speed dribbling, treadmill running test). Afterwards, match performance of each athlete was assessed by real time of playing (as a surrogate parameter) during the half season (14 and 25 matches). We finally compared test parameters with the match performance in a linear regression analysis.

RESULTS

Our analysis showed no statistical relevant relationship between test parameters and match performance (r(2) < 0.10). Only the assessment in maximum of relative oxygen uptake during the treadmill test for endurance was associated with a higher amount of variance (12%).

CONCLUSIONS

According to the study results there is no relevant and valid correlation between current established diagnostic tests in soccer sport and sport-specific performance. The time of real engagement during a match might be associated with a quality of performance for the single athlete. Therefore, the assessment of this match activity is the most important parameter for improving diagnostic tests in soccer. The existence of a "golden standard" is essential for validation of any tests and parameters and the development of new specific assessments. At the moment, physical performance tests have no scientific evidence in soccer sports.

2,4,6-Triphenylphosphinine and 2,4,6-triphenylposphabarrelene revisited: synthesis, reactivity and coordination chemistry

Important aspects of the synthesis, reactivity and coordination chemistry of 2,4,6-triphenylphosphinine and 2,4,6-triphenylphosphabarrelene have been revisited.

NMR Study of Molecular Dynamics in a D ho Columnar Mesophase

In this paper we report the first molecular dynamics study combining fast field-cycling and conven-tional NMR techniques in a thermotropic liquid crystal of discotic molecules exhibiting an ordered columnar hexagonal mesophase. Using the association of these techniques we obtained proton T1 data over a very large domain of Larmor frequencies (ω/2π from 500 Hz to 85 MHz). The proton spin-lattice relaxation results were analysed considering the structure of the mesophase and the types of movements which are expected to influence significantly the relaxation rate, namely local molecu-lar rotational reorientations, inter-columnar self-diffusion and collective movements corresponding to bending and compression of the columns. We verified that these mechanisms dominate the relaxation respectively for high, medium and low Larmor frequencies.

Dynamic Nuclear Polarization Experiments on 19F in Solutions and their Interpretation by the “Pulse Model” of Molecular Collisions

The dynamic fluorine polarization by the Overhauser effect has been studied at four different magnetic field values and at various temperatures in several fluorocarbon solutions. The importance of intermolecular contact couplings is very sensitively dependent on the chemical environment of the fluorine nuclei. The experimental data are interpreted in terms of the stochastic “pulse model” of molecular collisions derived in a preceding paper. The parameters of the model, such as the relative contribution of scalar couplings, the shape and the time scale of collision pulses and the correlation times of the molecular motion are given explicitly for six fluorocarbon solutions of free radicals.

Kernresonanzuntersuchung der Molekülrotation und Selbstdiffusion in festem Benzol: T1ϱ-Spektroskopie/ Nuclear Magnetic Resonance Investigation of Molecular Rotation and Diffusion in Solid Benzene: T1ϱ-Spectroscopy

We have extended previous NMR investigations of the molecular motion in solid benzene to lower proton spin Larmor frequencies using the rotating frame (T1ϱ) technique. The new data show two relaxation mechanisms, namely the well-known rotation of the benzene rings around their sixfold axis and, additionally, the self-diffusion by vacancies. The rotation and diffusion was analyzed by computer optimization of the relaxation models of Haeberlen and Torrey, respectively. The parameters of rotation are essentially consistent with results derived recently from high-frequency T1 measurements. The diffusion parameters are in agreement with preliminary low-frequency T1 measurements, but reveal a dramatic discrepancy by nearly 4 orders of magnitude with respect to tracer experiments of Fox and Sherwood. This behaviour is discussed in terms of correlation effects similar to those observed in plastic and liquid crystals.

Kernresonanzuntersuchung der Molekülrotation in festem Benzol: T1-Spektroskopie / Nuclear Magnetic Resonance Investigation of Molecular Rotation in Solid Benzene: T1-spectroscopy

We have extended Haeberlen’s and Maier’s NMR investigation of the molecular rotation in solid polycrystalline benzene (C6H6), performed in 1967 in the Larmor frequency range from 88 MHz to 22 MHz, to lower frequencies down to 4.4 MHz. In some cases monocrystalline samples were also studied. The extensive data show that the presently accepted model of purely uncorrected rotations of the benzene molecules around their sixfold axis has to be rejected. Instead, two results found, namely

- a slight increase of the rotational activation energy when approaching the melting point of benzene and

- the width of the T1 relaxation minima as a function of the reciprocal temperature suggest an additional relevance of correlated molecular motions, like e.g. the ‘gear-wheel mechanism’ first proposed by Cox. By appropriate modifications of Haeberlen’s theory, i.e. by assuming a rate equation with temperature dependent activation energy and by emphasizing the effect of simultaneous rotations of neighbouring rings compared with the purely statistical, uncorrelated case, we succeeded to describe the considered T1 measurements quantitatively.

Kernmagnetische Messungen von Selbstdiffusions-Koeffizienten in Wasser und Benzol bis zum kritischen Punkt

The most commonly used nuclear magnetic resonance spin-echo methods for determining selfdiffusion coefficients D are described; some experimental data are presented for protons in water and in benzene from room temperature up to the critical point. The results are interpreted in terms of the free-volume rate theory of MACEDO and LITOVITZ. The D-value of benzene may be described by a single activation energy. Water, however, shows such behavior only at high temperatures, thus demonstrating the strong influence of hydrogen bonding. The STOKES-EINSTEIN relation between diffusion coefficient and viscosity is well satisfied over that part of the temperature range where viscosity values are available.

NMR Investigation of Order Fluctuations, Self-Diffusion and Rotational Motions in the Nematic Liquid Crystal MBBA by T1-Relaxation Spectroscopy

We report on measurements of the proton spin T1 relaxation dispersion at various temperatures in the nematic phase of the liquid crystal MBBA in the Larmor frequency range from 2 kHz to 270 MHz, which exceeds previous studies by more than 3 orders of magnitude. The new results cannot be interpreted in terms of either order fluctuations or self-diffusion as recently proposed by Doane et al.1 and Blinc et al.2, respectively. Instead, the dispersion and its temperature dependence indicate the significance of at least three relaxation mechanisms, namely order fluctuations (OF), self-diffusion (SD) and rotation of the molecular ellipsoids about the short axis (R). The combined OF-SD-R model presented in this work allows a quantitative analysis of the experimental findings! The correlation times and activation energies of the three molecular reorientations evaluated from the T1 dispersion by means of a computer optimization procedure are in essential agreement with data provided by other spectroscopic methods [light scattering, tracer technique, dielectric relaxation], but differ from former NMR conclusions.

Kernmagnetische Messungen an einem linearen Polyäthylen I. Spin-Gitter-Relaxationszeit T1 und Linienform1

Die Spin-Gitter-Relaxationszeit T1 und die Form des Kernresonanzsignals der Protonen eines linearen Polyäthylens (Marlex 50, Typ 15) wurden mit einer Impulsapparatur bei 28 MHz zwischen —150°C und + 180°C untersucht. Die Ergebnisse an festem und geschmolzenem Polyäthylen lassen sich durch drei verschiedene Bewegungsformen der Polyäthylen-Moleküle erklären, die mit steigender Temperatur angeregt werden. Die Theorie von SOLOMON 2 wird dazu auf einige anisotrope Bewegungen angewandt.

Frequency Dependence of Proton Spin Relaxation in Liquid Crystalline PAA

We report on measurements of the Larmor frequency dependence of the proton spin relaxation time T1 in the nematic and isotropic phase of p-azoxyanisole (frequency range: 3.8 kHz ≦ ωL/2 π≦75 MHz) . In both cases our results clearly support the Pincus-Cahane mechanism of spin relaxation by order fluctuations ("ωL−½-law") and exclude the alternative translational dif­fusion model (“ωL+½-law”). For the isotropic phase it was possible to evaluate the correlation time τ of the liquid crystalline order fluctuations from the observed T1 dispersion. As a function of the deviation ⊿ν=ν-νc from the critical nematic-isotropic transition temperature, νc= (136± 0.5)°C, we found τ=2.71·10-7-⊿ν-0.25s .

Kernmagnetische Relaxation und Korrelation im System Wasser - Sauerstoff

The magnetic interaction between the electronic magnetic dipole moment of molecular oxygen dissolved in water and water protons has been investigated by measuring the nuclear magnetic proton relaxation times and their dependence upon oxygen pressure (10–2—200 at), upon the proton LARMOR frequency (0.45 — 160 Mc) and upon temperature (20°C—300°C). The results are interpreted in terms of microscopic correlation times. The dipolar interaction, which is dominant, appears to be modulated in time mainly by the correlation time τS of the 02 electron spin. At 25°C we obtain τS = (1 ± 0.4) · 10-11 sec for the O2 spin correlation time and d= 2.87 ± 0.15 Å for the effective distance of nearest approach between electron and proton spin. The value for the translational correlation time TD &gt; 1.3·10-11 sec at 25°C, somewhat larger than in pure water, might suggest a weak, short-lived bonding between O2 and H2O.

NMR Pulsed Field Gradient Study of Self-Diffusion in the Isotropic Phase of the Liquid Crystals MBBA and EBBA

In refinement of a previous study made by Hayward and Packer, the self-diffusion coefficients D of the nematogen liquid crystals MBBA and EBBA were remeasured in the isotropic phase by means of the NMR pulsed field gradient technique. In particular, the diffusion measurements were made for the first time at different Larmor frequencies. A comparison with results obtained recently on the same samples by NMR T1 relaxation analysis reveals a severe discrepancy. Since the gradient method gives results in essential agreement with optical spectroscopies, the observed discrepancy must be attributed to shortages of the relaxation analysis (incorrect models, insufficient experimental accuracy). It is also shown that D depends more strongly on the molecular weight m than m-1/2 .

Proton Spin Relaxation in Reentrant Nematic Cyano -biphenyl Liquid Crystals

The frequency dependence of the longitudinal proton spin relaxation time T1 was measured by field-cycling and standard NMR techniques in the nematic, smectic and reentrant nematic mesophases of the reentrant liquid crystal 6OCB-8OCB. The results clearly demonstrate that, in contrast to conclusions reported in the literature, the underlying relaxation mechanisms are the same for the nematic and reentrant nematic order, but different in the nematic and smectic phase. In particular, at low frequencies the nematic and reentrant samples reveal a square-root dispersion profile (T1,~ ν½) characteristic for nematic director fluctuations, whereas the smectic samples show a dissimilar and only very narrow dispersion step. It can be attributed to a linear relaxation time increase (T1 ~ v1) expected for smectic-type order fluctuations. The experimental data are described and discussed in terms of four molecular processes, namely nematic or smectic order fluctuations, self-diffusion, rotational motions, and a resonant proton nitrogen coupling.

NMR Study of Collective Motions and Bending Rigidity in Multilamellar System of Lipid and Surfactant Bilayers

The frequency dependence of the longitudinal proton spin relaxation time T1 was measured by field-cycling and standard NMR techniques at different temperatures in the liquid crystalline lamellar phases of bilayer systems, composed of lipids, nonionic surfactants, and lipid-surfactant mixtures. We show by our data analysis, comparing various motional models such as layer undulations (LUs) and relaxation by translational diffusion mediated reorientations (TR), that collective layer undulations with their typical T1~ν behaviour determine the low frequency T1 dispersion in both unoriented and glass plate-oriented bilayer systems. The angular dependence of the T1 dispersion for the oriented bilayer system supports these findings and provides a more critical analysis of the two dimensional self-diffusion than in unoriented samples. The evaluated fitting parameters of the LU model allows, together with the measured second moment of the proton NMR signal for the lipid, calculation of the bending rigidity ϰc for these bilayers at different levels of hydration. The obtained values of ϰc turn out to be too large compared with the literature. However, using recent LU models (B. Halle) which include the obvious couplings between neighbouring bilayers at low Larmor frequencies, the corrected ϰc of the fully hydrated membrane systems are comparable to those obtained from the standard videooptical experiments. Therefore proton spin relaxation measure-ments at low Larmor frequencies with the field-cycling technique are a suitable means to determine the bending rigidity ϰc of model membrane systems at low hydrations and of systems containing surfactants.

NMR Field-Cycling Study of Rotational Flow and Viscosity in Nematic Liquid Crystals

A proton NMR method is described which enables rotational flow and viscosity measurements of low molecular weight ṉematic ḻiquid c̱rystals (NLC's). This is achieved by an extension of the common NMR field-cycling technique, namely by fast electronic switching of both the external magnetic field direction and strength. In thermodynamic equilibrium, the director of an NLC with positive diamagnetic anisotropy (Δχ > 0) orients parallel to the external magnetic field. Thus a change of this direction causes a reorientation process of the molecules to align to the new equilib­rium, which in low viscous systems in contrast to polymer liquid crystals is rather fast and hence requires fast field switching. We have studied systematically this response as a function of the initial field rotation angle 90 relative to the director for some homologous NLC's of the n-alkyl-cyano-biphenyl (nCB) series. It is shown that there exists a critical angle θcr in such a way that for θo < θcr, however (e.g. in the case of 5 CB θcr is ≈ 85 degrees) the viscoelastic behaviour is more complicated because of a coupling between flow and director gradients. The analysis of the alignment process by the changes of the proton line spectra also allows to determine the Leslie viscosities α1, α2, α3, α4 + α5, and the average Frank elastic constant K̄ by a single measurement.

[Intraobserver reliability of the Handball-specific complex test (HBKT)]

BACKGROUND

There are clearly no complex and sports-specific tests in handball. So far, no specific complex test has been developed and verified for its intraobserver reliability (IR).

OBJECTIVE

The aim of this study was to determine the IR of the Handball-specific complex test (HBKT).

METHODS

The HBKT was applied twice at an interval of two days to two teams of the German Third League (n = 30; age 25.7 ± 3.9 years, range: 19 - 33 years). Within the HBKT, the stress parameters lactate and heart rate as well as the loading parameters time, throwing velocity and number of errors were collected.

RESULTS

Overall, 23 % (3/13) of the stress parameters showed a high relative [intraclass correlation coefficient (ICC) > 0.75] and absolute [coefficient of variation (CV) ≤ 5 %] IR. On average, a sufficient absolute (∅CV = 11.3 %) and relative (∅ICC = 0.67) IR was observed. Without the parameters "missed throws" and "technical errors" in both rounds, the IR increased significantly (∅ICC: from 0.67 to 0.72 & ∅CV from 11.3 to 6.3 %). The heart rate was comparatively more reliable than lactate (∅ICC = 0.71 & ∅CV = 4.23 % vs. ∅ICC = 0.65 & ∅CV = 15.1 %). With respect to load parameters in round one, 50 % (5/10) showed a high IR; in round two, these values decreased to 40 % (4/10). The mean IR of the parameters in round one was higher than in round two (∅ICC = 0.71 & ∅CV = 12.2 % vs. ∅ICC = 0.60 & ∅CV = 14.3 %). Overall, there was an improvement of the athletes in most stress and load parameters from session one to session two.

CONCLUSIONS

The HBKT can be attested with a sufficient intraobserver reliability. When the parameters "missed throws" and "technical errors" were excluded, the IR further increased significantly. Therefore, these parameters should be recorded in order to standardized the HBKT, but not be included in the statistical analysis. There are discrete adaptation and learning effects. For this reason, it is essential to familiarise trainers and players with the HBKT test procedure before the first measurement. Otherwise training effects can be easily overrated. Moreover, the test concept of HBKT can be used as a blueprint for the development of sport-specific tests in other team sports (e. g., soccer, basketball). For example, we generated a complex soccer-specific field test 1 based on the HBKT.

Androgen receptor expression: prognostic value in locally advanced squamous cell carcinoma of the head and neck

BACKGROUND AND PURPOSE

This study investigated the prognostic value of androgen receptor (AR) expression of tumor cells in patients treated with surgery and subsequent radio(chemo)therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN).

MATERIAL AND METHODS

The impact of AR and 11 additional factors on locoregional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively studied in 163 patients with nonmetastatic stage III/IV SCCHN. Additional factors included age, gender, ECOG performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T category, N category, HPV status, extent of resection, and concurrent chemotherapy.

RESULTS

On multivariate analysis, improved LRC was significantly associated with pre-RT hemoglobin levels≥12 g/dl (risk ratio [RR] 2.22; 95% confidence interval [CI] 1.19–4.13; p=0.013), tumor site (RR 1.39; 95% CI 1.14–1.70; p=0.001), lower T category (RR 1.67; 95% CI 1.18–2.44; p=0.003), and lower N category (RR 4.18; 95% CI 1.90–10.55; p<0.001). Improved MFS was associated with AR expression (RR 2.21; 95% CI 1.01–5.41; p=0.048), better ECOG performance status (RR 3.19; 95% CI 1.50–7.14; p=0.003), lower T category (RR 2.24; 95% CI 1.47–3.65; p<0.001), and lower N category (RR 5.33; 95% CI 2.07–16.63; p<0.001). OS was positively associated with AR expression (RR 1.99; 95% CI 1.06–4.00; p=0.032), better ECOG performance status (RR 2.20; 95% CI 1.20–4.09; p=0.010), pre-RT hemoglobin levels≥12 g/dl (RR 2.13; 95% CI 1.19–3.82; p=0.012), lower T category (RR 1.81; 95% CI 1.30–2.62; p<0.001), and lower N category (RR 3.41; 95% CI: 1.65–7.80; p<0.001).

CONCLUSION

Tumor cell expression of AR was an independent prognostic factor for MFS and OS and should be considered in future prospective trials.

Impact of the HPV-positivity definition on the prognostic value of HPV status in patients with locally advanced squamous cell carcinoma of the head and neck

BACKGROUND AND PURPOSE

This study re-evaluated the prognostic value of HPV status for loco-regional control (LRC), metastases-free survival (MFS), and survival (OS) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). A modified definition of HPV positivity was used in the current study compared to the authors' previous study.

PATIENTS AND METHODS

In the previous study of the same 170 patients, a tumor was defined as HPV-positive if it showed a positive in situ hybridization result in ≥10% of tumor cells and/or positive p16 immunostaining. In the current analysis, tumors were considered HPV-positive only if they showed positive results for both in situ hybridization and p16 immunostaining. In addition to HPV status, the same 11 potential prognostic factors were investigated for treatment outcomes as in the preceding study.

RESULTS

In the multivariate analysis of the current study, HPV positivity was significantly associated with improved LRC [risk ratio (RR) 9.78; p<0.001], MFS (RR 7.17; p=0.008), and OS (RR 6.61; p<0.001). In the previous study, HPV positivity was associated with LRC (RR 2.34; p=0.014) and OS (RR 2.19; p=0.019), but not with MFS (RR 2.04; p=0.11).

CONCLUSIONS

Applying the new definition of HPV positivity, the impact of HPV status on the prognosis of patients irradiated for locally advanced SCCHN was more prominent than in our previous study and associated with all three investigated endpoints.

Prognostic impact of VEGF and FLT-1 receptor expression in patients with locally advanced squamous cell carcinoma of the head and neck

BACKGROUND AND PURPOSE

This study investigated the prognostic value of tumor cell expression of vascular endothelial growth factor (VEGF) and its receptor fms-related tyrosine kinase 1 (FLT-1) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who had been treated with adjuvant radiotherapy or radiochemotherapy.

MATERIAL AND METHODS

The impact of tumor cell VEGF and FLT-1 expression plus 11 additional factors on loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) was retrospectively evaluated in 157 patients. The additional factors were age, gender, performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papillomavirus (HPV) status, extent of resection and chemotherapy.

RESULTS

On multivariate analysis, improved LRC was significantly associated with an absence of VEGF expression (risk ratio, RR: 5.02; p = 0.009), lower T-category (RR: 2.00; p < 0.001), lower N-category (RR: 3.75; p < 0.001) and pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.20; p = 0.029). Improved MFS was significantly associated with an absence of VEGF expression (RR: 7.46; p = 0.002), lower T-category (RR: 1.97; p = 0.002), lower N-category (RR: 3.29; p = 0.005) and a favorable tumor location (RR: 1.34; p = 0.033); HPV positivity showed a trend towards improved MFS (RR: 1.43; p = 0.09). Improved OS was significantly associated with an absence of VEFG expression (RR: 3.22; p = 0.041), pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.47; p = 0.009), lower T-category (RR: 1.92; p < 0.001) and lower N-category (RR: 3.39; p < 0.001). FLT-1 expression was significantly associated with LRC and OS in the univariate but not in the multivariate analysis.

CONCLUSION

VEGF expression proved to be an independent negative predictor for LRC, MFS and OS in patients treated for locally advanced SCCHN with adjuvant radiotherapy or radiochemotherapy. FLT-1 expression was not significant in multivariate analyses.