The prognostic significance of the biomarkers p21(WAF1/CIP1), p53, and bcl-2 in laryngeal squamous cell carcinoma

BACKGROUND. The clinical course of laryngeal squamous cell carcinoma (LSCC) varies considerably among patients. New biologic markers are needed to facilitate the stratification of individual patients within the conventional clinicopathologic stages of LSCC. METHODS. Eighty-three LSCCs from an equal number of patients who received at least 10 years of follow-up were investigated for p53, p21(WAF1/CIP1), and bcl-2 protein expression by immunohistochemical techniques. The results were correlated with various clinicopathologic parameters, DNA content, and patient outcome by univariate and multivariate statistical analyses. RESULTS. Stage IV disease, large tumor size (>3 cm), positive lymph node status, extranodal extension, and p53 overexpression (in > 75% of cells) correlated significantly with prognosis in univariate analysis. There was no correlation between patient outcome and age, gender, race, histologic differentiation, or expression of bcl-2 or p21(WAF1/CIP1). In multivariate analysis, lymph node status and p53 overexpression were the only factors significantly associated with survival. CONCLUSIONS. High p53 expression and positive lymph node status were independent predictors of the outcomes of patients with LSCC. These factors may assist in prognostication and better classification of patients for treatment.