Epidermal growth factor receptor (EGFR) content was determined by a radioligand receptor assay in 140 primary laryngeal squamous cell carcinomas (median value of 8.4 fmol mg-1 protein, range 0-169.9 fmol mg-1 protein). Cox univariate regression analysis using EGFR as a continuous variable showed that EGFR levels are directly associated with the risk of death (chi 2 = 14.56, P-value = 0.0001) and relapse (chi 2 = 7.77, P-value = 0.0053). A significant relationship between EGFR status and survival was observed at the different arbitrary cut-off values chosen (8, 16 and 20 fmol mg-1 protein). The cut-off value of 20 fmol mg-1 protein was the best prognostic discriminator. In fact, the 5 year survival was 81% for patients with EGFR- tumours compared with 25% for patients with EGFR+ tumours (P < 0.0001). The 5 year relapse-free survival was 77% for patients with EGFR- tumours compared with 24% for patients with EGFR+ tumours (P < 0.010). When clinicopathological parameters and EGFR status were examined in the multivariate analysis, T classification and EGFR status retained an independent prognostic value. In this study we demonstrated that high EGFR levels single out patients with poor prognosis in laryngeal cancer.

È stata condotta un’analisi retrospettiva su 482 pazienti con diagnosi di tumore testa-collo arruolati presso l’ ospedale “Agostino Gemelli” di Roma. L’associazione tra fattori demografici, clinici e comportamentali con la overall survival (OS), il rischio di ricorrenza ed il rischio di un secondo tumore primitivo è stata stimata usando gli Hazard Ratio (HR) e gli intervalli di confidenza al 95% (CIs). La OS considerando tutte le sedi tumorali è stata del 60%, mentre considerando le singole sedi tumorali è risultata del 49.0% per il cavo orale, 54.8% per l’orofaringe, 50.0% per l’ipofaringe e 63.4% per la laringe. Un’età avanzata alla diagnosi (HR = 1.04; 95% CI: 1.02-1.05) ed un avanzato stadio del tumore (HR = 2.00; 95% CI: 1.41-2.84) sono risultati fattori significativamente associati con la OS. Il rischio di ricorrenza è risultato associato con il consumo di alcolici (HR = 1.73; 95% CI: 1.00-2.97). Il rischio di sviluppare un secondo tumore primitivo è risutlato associato con uno stadio avanzato del tumore primario (HR = 2.75; 95% CI: 1.39-5.44) e con l’aver fumato per più di 40 anni (HR = 3.68; 95% CI: 1.10-12.30). In conclusione abbiamo notato che la OS differisce tra le sedi tumorali del tumore testa-collo. Lo stadio tumorale è risultato essere associato sia con la OS che con il rischo di sviluppare un secondo tumore primitivo. Il consumo di alcol e di tabacco sono risultati essere fattori prognostici, rispettivamente, per la ricorrenza e per l’insorgenza di un secondo tumore primitivo.

To compare the outcomes and the short- and long-term complications of percutaneous translaryngeal tracheostomy (TLT) and surgical tracheostomy (ST). Prospective, randomized clinical trial with 1-yr double-blind follow-up. A general intensive care unit of a university hospital. A total of 139 consecutive critically ill patients who required a tracheostomy between February 2001 and June 2002 were randomly assigned to receive either ST or TLT. TLTs were performed more rapidly than STs (17 ± 10 mins vs. 22 ± 6 mins, p = .003). Early complications were rare in both groups. Major postoperative bleeding was less frequent with TLT (0 [0%] vs. 6 [8%], p = .03). Only one case of bleeding (in the ST group) required blood transfusion. Immediately after tracheostomy, six TLT patients (9%) and six patients (8%) in the ST group (p = .56) developed culture-confirmed bacteremia with microbes previously isolated from the pharynx or trachea. Group rates for stomal infections and pneumonia after tracheostomy were similar. At 1-yr follow-up, the overall survival rate was 27%, and 14 patients (45% of survivors) still had open tracheostomies. Both groups rated their quality of life as moderately to severely compromised, and the deterioration was strictly related to the presence of tracheostomy. One TLT and two ST survivors (p = .53) had clinical signs of tracheal stenosis, and bronchoscopy revealed narrowing of >50%. Compared with ST, the main advantages of TLT are that it is more rapid and associated with less postoperative bleeding. Infectious complications, particularly postoperative bacteremia, and long-term effects (physical and emotional) are similar with the two procedures.

Human papillomavirus 16 infection has been proven to be associated with oropharyngeal squamous cell carcinomas (SCCs) and is probably the main reason of the reported increase in the incidence. The role of high-risk (HR) HPV for carcinogenesis of other sites in the head and neck awaits confirmation. With the aim to evaluate the prevalence of HPV infection and the reliability of different diagnostic tools in SCCs of different sites, 109 consecutive untreated head and neck SCCs were enroled, and fresh tumour samples collected. Human papillomavirus DNA was detected by Digene Hybrid Capture 2 (HC2). Human papillomavirus E6 and E7 mRNA were detected by NucliSENS EasyQ HPVv1. P16 expression was evaluated by immunohistochemistry. In all, 12.84% of cases were infected by HR genotypes and 1.84% by low-risk genotypes. Human papillomavirus 16 accounted for 87% of HR infections. The overall agreement between DNA and RNA detection is 99.1%. Although p16 expression clearly correlates with HPV infection (P=0.0051), the inter-rater agreement is poor (k=0.27). The oropharynx showed the highest HR HPV infection rate (47.6%) and was also the only site in which p16 immunohistochemistry revealed to be a fair, but not excellent, diagnostic assay (κ=0.61). The prognostic role of HR HPV infection in oropharyngeal oncology, with its potential clinical applications, underscores the need for a consensus on the most appropriate detection methods. The present results suggest that viral mRNA detection could be the standard for fresh samples, whereas DNA detection could be routinely used in formalin-fixed, paraffin-embedded samples.