The utility of molecular diagnostics to predict recurrence of head and neck carcinoma.
BACKGROUND
Locoregional recurrence is the major cause of treatment failure after surgery for oral squamous cell carcinoma. Molecular diagnostics have the potential to improve on clinicopathological parameters to predict this recurrence and plan adjuvant treatment. The test most frequently applied is based on detecting TP53 mutations, but alternative methodology is required for cases that harbour the wild-type gene.


METHODS
One hundred and two cases with tumour-adjacent margins, considered to be clear margins by microscopy, were examined using carefully optimised molecular diagnostics based on detection of the TP53 and Ly-6D markers. The markers were also combined to provide a dual approach.


RESULTS
The dual molecular diagnostic identified cases with a significant increase in the probablility of developing locoregional recurrence when tumour-adjacent positive and clear margins were compared (P=0.0001). These tests were most useful when the clearance at the resection margins was 5 mm or less. The TP53-based diagnostic was a better predictor of locoregional recurrence than established clinicopathological parameters.


CONCLUSIONS
The optimised TP53-based diagnostic rapidly identifies an important subgroup of cases with close margins that will benefit from new treatment modalities to reduce the risk of recurrence.
Head and Neck Unit, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK.
C
C
Pena Murillo
X
X
Huang
A
A
Hills
M
M
McGurk
A
A
Lyons
J-P
JP
Jeannon
E
E
Odell
A
A
Brown
K
K
Lavery
W
W
Barrett
M
M
Sherriff
R
R
Brakenhoff
M
M
Partridge
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D005260:Female; D016158:Genes, p53; D006258:Head and Neck Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D057089:Pathology, Molecular / Q000379:methods*; D011446:Prospective Studies
D014408:Biomarkers, Tumor