p53 overexpression on the resection margins as a marker of local recurrence in glottic T1a carcinoma.

Glottic carcinoma, in the early stage, may benefit, with excellent results "quoad vitam atque quoad valitudinem", from various modes of treatment--radiotherapy, laser microsurgery and cordectomy being the most common--in definitive cure of the disease. Nevertheless, recurrence, in relation to treatment, oscillates between 4.3-24.1% with laser CO2 surgery, 5.5-32.4% for cordectomy and 5.3-34% for radiotherapy. Prognostic biological markers of recurrence remain to be elucidated, mainly due to the clinical differences in the subjects examined. The present study focused on patients with glottic T1a carcinoma treated with CO2 laser surgery in which correlation between histo-pathological aspects and expression of p53 protein on resection borders were confirmed by onset of local recurrence. Study population comprised 39 patients treated with CO2 laser surgery (January 1985-December 1991) in Clinical Division of Otorhinolarygology, University of Catania. Survival rate, free from recurrence, at 3 and 5 years for this patient group was 87.1% (34/39) and 82% (32/39), respectively. Disease-free survival at 3 and 5 years, was 86.6% in patients with positive resection margins for carcinoma and 87.5% and 79.1%, respectively, for patients with negative resection margins. Survival rate, free from local recurrence, in p53 positive patients, at 3 and 5 years was 78.9% and 68.4%, respectively. In p53 negative patients, survival, free from local recurrence, at 3 and 5 years, was 94.7%. Presence of overexpression of oncoprotein p53 on borders of resection with aspects of dysplasia of various degrees seems, therefore, a marker of high risk of tumour progression and recurrence.