Elsevier

Human Pathology

Volume 39, Issue 3, March 2008, Pages 344-349
Human Pathology

Original contribution
Epidermal growth factor receptor: a novel biomarker for aggressive head and neck cutaneous squamous cell carcinoma

https://doi.org/10.1016/j.humpath.2007.07.004Get rights and content

Summary

There is currently no prognostic tool that reliably predicts the risk of metastasis in cutaneous squamous cell carcinoma, most of which occur in the head and neck region. Epidermal growth factor receptor has received much interest in recent years with the advent of epidermal growth factor receptor–targeted molecular therapy in clinical oncology. We investigate the role of epidermal growth factor receptor as a biomarker for head and neck cutaneous squamous cell carcinoma. Using immunohistochemistry and fluorescence in situ hybridization, we assessed the epidermal growth factor receptor protein expression and gene copy in 3 groups of head and neck cutaneous squamous cell carcinoma: primary lesions not associated with metastasis (P), primary lesions associated with subsequent metastasis (PM), and metastatic nodal disease (M). Epidermal growth factor receptor overexpression was detected in 36% and 79% of P and PM cases, respectively. Epidermal growth factor receptor overexpression was significantly associated with PM (P = .03) and was found to be an independent prognostic factor for metastasis on multivariate analysis (P = .05). However, epidermal growth factor receptor overexpression was only maintained in 47% of cases in the M group. None of the 27 cases that overexpressed the epidermal growth factor receptor protein showed gene amplification: the results were uninterpretable in 2, and polysomy and balanced disomy were detected in 5 and 20 cases, respectively. These observations may have important prognostic and therapeutic implications for head and neck cutaneous squamous cell carcinoma.

Section snippets

Background

Squamous cell carcinoma (SCC) is the second commonest cutaneous malignancy, with 60% occurring in the head and neck region. Most primary SCCs are curable. However, there is a 14% incidence of metastasis for cutaneous SCC in the head and neck, which carries a mortality of up to 40% [1], [2], [3]. Histologic parameters such as tumor depth, degree of differentiation, perineural spread, and vascular and lymphatic invasion in the primary SCC are known to be associated with worse prognosis [3].

Patient selection

Patients with head and neck cutaneous SCCs treated at the Wellington Regional Plastic, Maxillofacial, and Burns Unit over the past decade were identified from our prospective head and neck database. Fifty-four cases of SCC treated between 1998 and 2005 were retrieved from the archives at the Department of Pathology, Hutt Hospital. There were 14 cases of primary SCC with concurrent or subsequent metastasis (PM group), 15 cases of metastatic SCCs (M group), and 25 primary SCCs without metastasis

Results

The clinicopathologic features of the specimens are presented in Table 2. There was no significant difference in these features between the P and PM groups.

Immunoreactivity to EGFR was detected in all primary SCCs. In the P group, 3 (12%) cases exhibited weak, 13 (52%) showed moderate, and the remaining 9 (36%) displayed strong staining intensity. The staining was moderate and strong in 3 (21%) and 11 (79%) cases of the PM group, respectively. PM was significantly associated with overexpression

Discussion

EGFR has been found to be overexpressed in many epithelial malignancies including carcinomas of the colorectum, stomach, esophagus, pancreas, oropharynx, and non–small cell carcinoma of the lung [11]. The mechanism that leads to protein overexpression appears varied. Our study shows that EGFR overexpression is significantly associated with metastatic potential in head and neck cutaneous SCC. In addition, our results also suggest that EGFR overexpression in cutaneous SCC is independent of gene

Acknowledgment

We are grateful to Professor Chris Sissons at the Wellington School of Medicine & Health Sciences for access to the facilities in his laboratory for some aspects of this project, and Paul Oei at Innovative Genetic Diagnosis (IGENZ; Auckland, New Zealand) for his expertise and technical support in FISH.

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  • Cited by (0)

    We thank the Reconstructive Plastic Surgery Research Foundation and the Sir William and Lady Manchester Trust for their financial support.

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