Purpose: The prognostic value of proliferative activity (percentage of S-phase cells = SPF) was determined in head and neck and nodal negative breast carcinomas and correlated with treatment outcome and analysis of recurrence.
Methods and material: SPF of 171 primary squamous cell carcinomas of the head and neck and 183 nodal negative breast carcinomas was determined by one-dimensional flow cytometry.
Results: For the whole population of head and neck carcinomas slowly proliferating tumors (SPF < median) had a better five-year survival rate (28%) than fast proliferating tumors (S-phase > median; 20% p < 0.05). Failure analysis revealed that the better survival of slowly proliferating tumors was due to the higher loco-regional control rate (62%) compared to fast proliferating tumors (43%; p < 0.05). Stepwise multivariate analysis revealed treatment modality (p = 0.107), SPF (p = 0.026) and UICC stage (p = 0.044) as independent prognostic factors for loco-regional recurrences and SPF (p = 0.0143) for three-year overall survival. In nodal negative breast cancer slowly proliferating tumors (SPF < median) had a better NED survival (92%) compared to fast proliferating tumors (SPF > median; NED survival 63%). The analysis of recurrence revealed a higher rate of distant metastases (15.7%) and of loco-regional recurrences (21%) for fast proliferating tumors as compared to slowly proliferating tumors (distant metastases: 1.1%; loco-regional recurrences 4.5%). Stepwise multivariate analysis showed that SPF (p = 0.001) was the only independent prognostic factor for NED survival; grading (p = 0.022), age (p = 0.003) and SPF (p = 0.007) for freedom from distant metastases; SPF (p = 0.0039), grading (p = 0.0956) and method of surgical treatment (p = 0.0715) for loco-regional recurrences.
Conclusions: SPF has a relevant prognostic power for squamous cell head and neck cancer and nodal negative breast cancer.