Gene test could identify head and neck metastasis, reduce overtreatment
MedWire News: A novel gene-expression signature could identify which patients with head and neck squamous cell carcinoma (HNSCC) have a metastasizing form of the disease, and which do not, report Dutch researchers.
The team believes the approach could lead to a reduction in overtreatment of HNSCC.
"It is impossible with current diagnostic tools to detect a small lymph node metastasis in patients with HNSCC and therefore it is common practice to operate on the neck even if no metastases have been detected," said Robert Takes from Radboud University Nijmegen Medical Center in The Netherlands.
"The majority of these operations are unnecessary because, in most cases, no metastases are present," he added.
Takes presented the findings at the European Society for Medical Oncology's 3rd International Conference on Innovative Approaches in Head and Neck Oncology in Barcelona, Spain last week.
The initial study included samples from 222 HNSCC patients, with a subanalysis carried out on 143 patients with clinically node negative (cN0) tumors, and 101 patients who had stage T1 and T2, cN0 oral cavity tumors.
The researchers examined gene expression in these samples using a DNA microarray analysis that represented 696 genes previously reported to be predictive of HNSCC metastases.
Using the results of the microarray to create a "gene signature", they calculated the signature's negative predictive value (NPV) for identifying HNSCC metastases. Neck dissection specimens were used to confirm the results obtained with the signature.
Takes et al report an overall NPV of 72%.
The signature performed better when the cN0 subcohort were assessed separately, giving a NPV of 85%, which increased to an NPV of 89% when used among the "clinically most relevant" T1 and T2, cN0 oral cavity patients.
"This is the first biological test that was able to obtain a high level of accuracy and has been validated in multiple centers on a large cohort of patients," said Takes.
"The possible reduction of unnecessary neck treatments in case of a negative test may result in decreased morbidity without deterioration of oncological outcomes. Also, in the remaining cases that still develop metastasis in the neck, salvage treatment is still possible," he concluded.
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By Sarah Guy