Molecular analysis of surgical margins in @entity213 XXXX .

@entity1 @entity135 @entity5 @entity876 @entity982 @entity1495 @entity213
OBJECTIVES/HYPOTHESIS: Molecular analysis of surgical margins is playing an increasingly important role in establishing surgical margins. Most markers lack the sensitivity and ease of applicability for effective clinical use. To date, the proto-oncogene eIF4E (4E) is elevated in 100% of @entity213 and is of prognostic value in predicting recurrence. In a retrospective study, 4E overexpression in the margins appeared to be a more sensitive predictor of recurrence when compared with @entity876 . The goal was to confirm this finding in a prospective study and also to compare the expression of @entity1495 ( @entity1495 ) to 4E expression in @entity5 and margins. Other objectives were to determine which of these markers have prognostic significance in predicting recurrence and elucidate whether there is any additional benefit to analysis of surgical margins with a combination of the three molecular markers. STUDY DESIGN: A prospective study was performed on all @entity1 who consecutively underwent primary surgical resection between 1998 and 1999 for @entity213 . @entity1 and @entity5 characteristics were reviewed, and time to recurrence was noted. METHODS: @entity982 -embedded sections of @entity5 and all histologically @entity5 -free margins were analyzed for the presence or absence of 4E, @entity876 , and @entity1495 with immunohistochemical analysis. @entity1 were followed according to the institution's @entity135 protocol, and time to recurrence was noted. RESULTS: Ninety-eight percent of @entity5 overexpressed 4E, 65% overexpressed @entity876 , and 92% overexpressed @entity1495 . Of the 52 @entity1 with @entity5 -free margins, 52%, 46%, and 54% had positive margins for 4E, @entity876 , and @entity1495 , respectively. Although no significant correlation between 4E and @entity876 expression was seen in the margins (P =.16), a significant correlation between 4E and @entity1495 expression was noted (P =.0002). However, when expression of 4E and @entity876 in the margins of only the @entity1 who overexpressed @entity876 in the @entity5 was compared (n = 34), there was a significant correlation (P =.04). There was also a significant difference in the disease-free interval between @entity1 with 4E-positive and 4E-negative margins (P =.003). This difference in time to recurrence was not significant for the @entity876 -positive versus the @entity876 -negative group (P =.18) but approached significance when @entity1495 was used as a marker (P =.07). Although the univariate analysis showed that stage, nodal disease, grade, and 4E expression in the margins were significantly associated with disease-free interval, in the Cox multiple regression analysis, only 4E expression in the margin was significantly associated with disease-free interval (P =.01). CONCLUSIONS: The era for molecular analysis of surgical margins is here. Although a significant correlation was seen between 4E and @entity1495 , overexpression of 4E appears to be a significant predictor of recurrence when compared with the well-studied @entity5 suppressor gene @entity876 and a relatively novel marker, @entity1495 .
