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  , . 181: 348 (1997)
We would like to thank Dr Ogden for his comments.
Although little has been published on the expression of
CK-16 in head and neck cancer, limited data are available indicating that its expression increases during the
carcinogenesis process, as published by van der Velden
et al.1 and Morgan et al.2,3 In addition, it was hypothesized that being a marker of hyperproliferation, its
expression might reflect increased levels of cell turnover,
as can be expected in (pre-)malignant tissue. This
marker could then act as a delayed form of other
well-known proliferation markers like KI-67 expression.
With respect to the occurrence of second primary
tumours in relation to marker expression, this question
cannot be answered. At this moment, the number of
patients with a second primary tumour is too low to
allow proper analysis. There is a chance that other risk
factors (smoking, age, and variation in duration of
follow-up) may play a confounding role. To correct for
these other possible risk factors, it may very well be that
25 patients in the starting group is not enough. A further
complication is that this group of patients is heterogeneous with respect to the TNM stage. We have
already noted that a significant proportion of the
patients, mainly those with a relatively high TNM stage,
? 1997 by John Wiley & Sons, Ltd.
did not have the chance to experience a second primary
tumour because they died of their first tumour. To prove
the role of these markers in a definitive setting, we have
collected cytological samples of a new group of over 100
patients with only early stage tumours, who will now be
followed up for a sufficient period of time to allow this
question to be resolved.
B. J. M. B  G. B. S
Department of Otolaryngology
Academisch Ziekenhuis
Vrije Universiteit
P.O. Box 7057
1007 MB Amsterdam
The Netherlands
van der Velden L-A, Schaafsma HE, Manni JJ, Ramaekers FCS, Kuijpers
W. Cytokeratin expression in normal and (pre)malignant head and neck
epithelia. Head Neck 1992; 15: 133–146.
Morgan PR, Shirlaw PJ, Johnson NW, Leigh IM, Lane EB. Potential
applications of anti-keratin antibodies in oral diagnosis. J Oral Pathol 1987;
16: 212–222.
Morgan PR, Su L. Intermediate filaments in oral neoplasia. I. Oral cancer
and epithelial dysplasia. Oral Oncol Eur J Cancer 1994; 30B: 160–166.
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