Molecular prognostic indicators for oropharyngeal squamous cell carcinoma (OSCC), including HPV‐DNA detection, epidermal growth factor receptor (EGFR) and p16 expression, have been suggested in the literature, but none of these are currently used in clinical practice. To compare these predictors, 106 newly diagnosed OSCC for the presence of HPV‐DNA and expression of p16 and EGFR were analyzed. The 5‐year disease‐free survival (DFS) and overall survival (OS) were calculated in relation to these markers and a multivariate Cox analysis was performed. Twenty‐eight percent of the cases contained oncogenic HPV‐DNA and 30% were positive for p16. The p16 expression was highly correlated with the presence of HPV‐DNA (p < 0.001). Univariate analysis of the 5‐year DFS revealed a significantly better outcome for patients with p16‐positive tumors (84% vs. 49%, p = 0.009). EGFR‐negative tumors showed a tendency toward a better prognosis in DFS (74% vs. 47%, p = 0.084) and OS (70% vs. 45%, p = 0.100). Remarkable and highly significant was the combination of p16 and EGFR expression status, leading to 5‐year DFS of 93% for p16+/EGFR− tumors vs. 39% for p16−/EGFR+ tumors (p = 0.003) and to a 5‐year OS of 79% vs. 38%, respectively (p = 0.010). In multivariate analysis p16 remained a highly significant prognostic marker for DFS (p = 0.030) showing a 7.5‐fold increased risk for relapse in patients with p16‐negative tumors. Our data indicate that p16 expression is the most reliable prognostic marker for OSCC and further might be a surrogate marker for HPV‐positive OSCC. HPV+/p16+ tumors tended to have decreased EGFR expression, but using both immunohistological markers has significant prognostic implications.

Introduction Aggressive variants of papillary thyroid cancer (PTC) have been described with increasing frequency. These variants include diffuse sclerosing variant, tall cell variant, columnar cell variant, solid variant, and hobnail variant. Methods We have performed a review of the more aggressive variants of PTC with respect to main characteristics, histological and molecular features, and the consequences that the knowledge of these variants should have in the treatment of the patients. Results At the present time, we do not know the prognostic value of these aggressive PTC variants. The extent of the surgical treatment and adjuvant therapy necessary should be decided on the basis of the extent of the tumor at presentation and the opinion of experienced clinicians. Conclusion These aggressive variants should be known by clinicians, to avoid underdiagnosis, and treated according to the latest recommendations in the literature.

THE TREATMENT of salivary gland cancers is challenging because of their infrequent incidence and their varied biologic behavior.¹ In addition, prognostic estimates are more difficult, owing to their prolonged risk for recurrence.¹ The standard treatment of primary salivary gland cancers is surgical resection.^2,3 Postoperative radiation therapy is believed to be indicated for most patients following initial surgery. However, there is no agreement on the management of the neck. Some authors recommend elective neck dissection (ND) only for specific histologic entities that are associated with the highest risk for lymph node metastasis.⁴ In line with this is a recent comment that ND be considered in the clinically uninvolved neck only in primary squamous cell carcinoma, undifferentiated carcinoma, adenosquamous carcinoma, salivary duct carcinoma malignant mixed tumors, and high-grade mucoepidermoid carcinoma.⁵ The overall incidence of clinically obvious lymph node metastasis is reported to range from 14%⁶ to 20%.^7,8 The reported incidence of occult lymph node metastasis varies from 12%⁶ to 48%.⁴ However, since current thinking is that elective ND is rarely (if ever) indicated,⁹ most of these estimates are based on small numbers of patients in whom elective ND has permitted for histologic assessment of lymph node metastasis. In most of the studies,⁶ irradiation was the preferred treatment of potential metastatic deposits in the lymph nodes and irradiation of the neck is believed to treat the N0 neck adequately.