Anaplastic Nuclei and Tumor Cell Multinucleation Are Strong Predictors of Poorer Survival in Nonkeratinizing Oropharyngeal Squamous Cell Carcinoma.
Juliette B Scantlebury, Qin Zhang, Wade L Thorstad, Bruce Haughey, James S Lewis. Washington University Saint Louis, St. Louis, MO
Background: Oropharyngeal squamous cell carcinoma (SCC) is frequently human papillomavirus (HPV) related. These tumors have a better prognosis, express p16, and frequently have a nonkeratinizing (NK) morphology. We have observed focal or diffuse nuclear anaplasia and/or multinucleation in NKSCC. Our aim was to determine if these features correlate with outcome.
Design: From a database of oropharyngeal SCC for which histologic typing (according to our established system) and p16 status were previously determined, we selected all surgically resected NK and hybrid SCC (excluded keratinizing SCC). Anaplasia was defined as any 40X field with ≥ 3 nuclei with diameters of ≥5 lymphocyte nuclei (≥30 microns). Multinucleation was defined as any 40X field with ≥ 3 cells with multiple nuclei.
Results: Of the 125 cases, 121 (96.8%) were p16 positive. 94 were NKSCC and 31 hybrid SCC. 49 (39.2 %) showed anaplasia and 54 (43.2%) multinucleation. Anaplasia and multinucleation were highly related (p<0.0001). Neither was correlated with any of the other major variables. Average follow up was 3.9 years, and 25 patients had died at the end of the study period. In univariate analysis, cases with anaplasia had worse overall and disease specific survival (p= 0.076 and 0.004, respectively). Multinucleation cases had worse overall, disease free, and disease specific survival (p= 0.034, 0.031 and 0.007, respectively). Higher T-stage correlated with worse overall, disease free, and disease specific survival (p= 0.0077, 0.0082, and 0.010, respectively). No other variables correlated with survival including histologic type, smoking, N-stage, overall stage, sex, and margins (p16 not analyzed due to too few negative cases). In multivariate analysis, there was worse 5 year overall, disease free, and disease specific survival with anaplasia (p= 0.028, 0.66, and 0.024, respectively) and with multinucleation (p= 0.049, 0.055, and 0.049, respectively).
Conclusions: Among the best prognosis group of oropharyngeal SCC (nonkeratinizing types and p16 expressing) which are surgically resectable, anaplastic and multinucleated histologic features independently predict poorer outcomes.
Category: Head & Neck
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 153, Monday Morning