title: Prognostic significance of tumor hypoxia inducible factor-1alpha expression for outcome after radiotherapy in oropharyngeal cancer.
abstract: OBJECTIVE
  Head-and-neck squamous cell carcinoma (HNSCC) represents a heterogeneous group of patients in terms of subsite, treatment, and biology. Currently most management decisions are based on clinical parameters with little appreciation of patient differences in underlying tumor biology. We investigated the prognostic significance of clinicopathologic features and tumor hypoxia-inducible factor-1alpha (HIF-1alpha) expression in a homogeneous series of patients who underwent radiotherapy.
  
  
  METHODS
  An audit identified 133 consecutive patients with histologically proven squamous cell carcinoma of the tonsil or tongue base. All patients received primary radiotherapy between 1996 and 2001. Tumor HIF-1alpha expression was examined in 79 patients.
  
  
  RESULTS
  Features associated with poor locoregional control were low Hb level (p = 0.05) and advancing T (p = 0.008), N (p = 0.03), and disease (p = 0.008) stage. HIF-1alpha expression was a more significant adverse prognostic factor in the tonsil (hazard ratio [HR], 23.1; 95% confidence interval [CI]. 3.04-176.7) than the tongue-base tumor (HR, 2.86; 95% CI, 1.14-7.19) group (p = 0.03, test for interaction). High tumor HIF-1alpha expression was associated with low blood Hb levels (p = 0.03). In a multivariate analysis HIF-1alpha expression retained prognostic significance for locoregional control (HR, 7.10; 95% CI, 3.07-16.43) and cancer-specific survival (HR, 9.19; 95% CI, 3.90-21.6).
  
  
  CONCLUSIONS
  There are significant differences in radiation therapy outcome within a homogeneous subsite of the oropharynx related to molecular marker expression. The work highlights the importance of studying homogeneous groups of patients in HNSCC, and the complex interrelationships between tumor biology and clinicopathologic factors. The establishment of tumor-type specific markers would represent a major advance in this area.
authors.affiliation: Academic Radiation Oncology, The University of Manchester, Manchester, United Kingdom.
authors.forename: Priyamal
authors.initials: P
authors.lastname: Silva
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Slevin
authors.forename: Philip
authors.initials: P
authors.lastname: Sloan
authors.forename: Helen
authors.initials: H
authors.lastname: Valentine
authors.forename: Jo
authors.initials: J
authors.lastname: Cresswell
authors.forename: David
authors.initials: D
authors.lastname: Ryder
authors.forename: Patricia
authors.initials: P
authors.lastname: Price
authors.forename: Jarrod J
authors.initials: JJ
authors.lastname: Homer
authors.forename: Catharine M L
authors.initials: CM
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000532:radiotherapy; D005260:Female; D015972:Gene Expression Regulation, Neoplastic / Q000528:radiation effects*; D006258:Head and Neck Neoplasms / Q000235:genetics / Q000532:radiotherapy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000235:genetics* / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000235:genetics / Q000532:radiotherapy; D014067:Tonsillar Neoplasms / Q000235:genetics / Q000532:radiotherapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C497442:HIF1A protein, human; D006454:Hemoglobins; D051795:Hypoxia-Inducible Factor 1, alpha Subunit