High CXCR4 expression in adenoid cystic carcinoma of the head and neck is associated with increased risk of locoregional recurrence

• Published in: Journal of clinical pathology Vol. 73; no. 8; pp. 476 - 482
• Main Authors: Klein Nulent, Thomas J W, van Es, Robert J J, Valstar, Matthijs H, Smeele, Ludwig E, Smit, Laura A, Klein Gunnewiek, Raquel, Zuithoff, Nicolaas P A, de Keizer, Bart, de Bree, Remco, Willems, Stefan M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2020
• Subjects: Antibodies; Chemokines; Ligands; Metastasis; Oral cancer; Patients; Radiation therapy; Tumors; Netherlands; immunohistochemistry; surgical pathology; carcinoma; salivary gland tumours
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jclinpath-2019-206273

AimTreatment options for head and neck adenoid cystic carcinoma (AdCC) are limited in advanced disease. Chemokine receptor type 4 (CXCR4) is present in various tumour types, including AdCC. Upregulation is associated with tumour recurrence and metastasis. New CXCR4-specific diagnostic and therapeutic target agents have recently been available. This study aimed to analyse CXCR4 expression in a cohort of primary head and neck AdCC.MethodsAfter histopathological revision, tumour tissues of 73 consecutive patients with AdCC over 1990–2016 were sampled on a tissue microarray. Slides were immunohistochemically stained for CXCR4 and semiquantitatively scored. Associations between protein expression and cliniopathological parameters were tested. HRs were calculated using a Cox proportional hazard model.ResultsSixty-six tumours could be analysed. CXCR4 expression was present in 81% of the tumours with a median of 29% (IQR 1–70) positive cells. Expression was univariately correlated to perineural growth (Spearman ρ .26, p=0.04) and bone invasion (Spearman ρ .32, p=0.01), but not with tumour grade.CXCR4 expression in the primary tumour was significantly higher in tumours that recurred as compared with those that did not recur (median 60%, IQR 33–72 vs 12%, IQR 1–70, Kruskal-Wallis p=0.01). After dichotomisation, >25% of CXCR4 expressions proved an independent prognosticator for a reduced recurrence-free survival (RFS) (HR 7.2, 95% CI 1.5 to 72.4, p=0.04).ConclusionCXCR4 is expressed in the majority of primary AdCCs and independently correlated to worse RFS, suggesting CXCR4 as a target for imaging and therapy purposes in patients with advanced AdCC.