Prognostic value of hypoxia-inducible factors (angiogenin and endoglin) in open partial laryngectomies: uni - and multivariate analyses.

Purpose Advances in transoral laser microsurgery, radiotherapy and chemotherapy (and their combinations) have reduced the indications for open partial laryngectomies, though they have replaced total laryngectomies in selected advanced or recurrent laryngeal carcinomas (LSCC). Tissue hypoxia in malignancies appears to be strongly associated with tumor cell invasiveness and metastases. Whether hypoxia-inducible factors can contribute to a rational recommendation of open partial laryngectomy should be investigated. Materials and Methods Fifty consecutive patients who had undergone open partial laryngectomy (supraglottic and supracricoid laryngectomies) were investigated, measuring the immunohistochemical expression of the hypoxia-inducible proteins angiogenin and endoglin in their primary LSCCs, also with image analysis. Results Univariate analysis showed a significantly higher recurrence rate (p=0.007) and shorter disease-free survival (DFS) (p=0.0047) in LSCC patients with endoglin expressions >9.0%. Multivariate analysis found endoglin expression independently prognostic in terms of DFS (p=0.012). Angiogenin expression (in carcinoma or endothelial cells) was not associated with prognosis. Conclusions Endoglin should be further studied as a biomarker of LSCC patients at higher risk of recurrence after open partial laryngectomy, who may benefit from more aggressive treatments. Endoglin expression in positive laryngeal biopsies may prove useful as a parameter for choosing between different surgical and multimodality approaches to controversial LSCC cases.