Expression of p16, Ki-67, and Bcl-2 in Head and Neck Squamous Cell Carcinoma Treated whit Chemoradiotherapy
Abstract
Introduction: Squamous cell carcinoma of the head and neck is the seventh most common cancer worldwide, and in Cuba, it is the fifth leading cause of cancer incidence and the sixth leading cause of cancer death. It represents a significant social and health problem.
Objective: Evaluar the efficacy and safety of hypofractionated radiotherapy compared with normofractionated radiotherapy.
Methods: The prognostic and predictive utility of the biomarkers p16, Ki-67, and Bcl-2 was evaluated in 75 patients using immunohistochemistry. Their association with clinical response and survival was analyzed in a multinational, randomized, non-inferiority, phase III clinical trial. The trial's objective was to evaluate the efficacy and safety of hypofractionated radiotherapy compared to normofractionated radiotherapy. Patients were not randomized based on the expression of these biomarkers.
Results: Median survival did not reach nine years in patients expressing p16, while it was four years in p16-negative patients. The absence of Bcl-2 was associated with better survival (6.3 years vs. 3.8 years when Bcl-2 was positive). The combination of p16 positivity and Bcl-2 negativity correlated with a better clinical response and a five- year overall survival rate of 66.7 %. In contrast, p16 negativity and Bcl-2 positivity increased the risk of treatment resistance more than sevenfold and was associated with lower survival. Ki-67 expression ≤ 20 % showed a trend toward improved survival, but this was not statistically significant.
Conclusions: The p16 and Bcl-2 biomarkers proved useful as prognostic and predictive markers in this context, relevant for personalized treatment of patients with head and neck cancers treated with chemoradiotherapy.
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Copyright (c) 2026 Misleidy Nápoles Morales, Xiomara Escobar Pérez, Jenny Carolina Ávila Pérez, Janet Lamadrid García, Johannes René Méstre Cabello, Carlos Frómeta Neira, Ariel Ventura Díaz, Adriana Carr Pérez, Ramón de Jesús Ropero Toirac, María Elena Faxas García, Amilcar Duquesne Alderete
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