Evaluation of epithelial mesenchymal transition markers snail and slug as predictor of nodal metastasis in oral squamous cell carcinoma
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20204953Keywords:
Head neck cancer, Oral cancer, EMT, Snail and slugAbstract
Background: Presence of regional neck node metastasis in head and neck cancer is a major determinant of overall survival. In patients presenting with neck node metastasis, there is a fifty percent decrease in overall survival, irrespective of the treatment modality. Tumor, nodes, metastases staging system, based on the anatomical extent of disease is used to predict patient prognosis and need for adjuvant treatment. Advent of immune based therapy has led to development of new molecular markers which can predict the disease aggressiveness by predicting lymph node and distal metastasis. Epithelial mesenchymal transition (EMT) in cancer is thought to convert the stable epithelial cells to mesenchymal cells that acquire properties of invasion with regional and distal metastasis.
Methods: In the current study we evaluated the expression of EMT markers snail and slug in oral squamous cell carcinoma with and without neck node metastasis in 86 patients.
Results: In this study, snail positivity was observed in 72 cases (83.72%), slug positivity was observed in 52 cases (60.46%) and either of the two expressions was observed in 77 cases (89.53%). Found that snail was significantly associated with clinical nodal status (p=0.037) and post-op histopathological nodal status (p=0.003). Also found that slug was significantly associated with clinical nodal status (p<0.001), post-op histopathological nodal status (p=0.001) and perineural invasion (p=0.003).
Conclusions: Snail and slug positivity correlates with clinical and post-op histopathological nodal status and thus can be used as a predictor of nodal metastasis in oral squamous cell carcinoma.
References
Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, Abbasi N, Abbastabar H, Abd-Allah F et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017. JAMA Oncol. 2019;5(12):1749-68.
Asthana S, Patil RS, Labani S. Tobacco-related cancers in India: A review of incidence reported from population-based cancer registries. Indian J Med Paediatr Oncol. 2016;37(3):152-7.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86.
Balaram P, Sridhar H, Rajkumar T, Vaccarella S, Herrero R, Nandakumar A et al. Oral cancer in Southern India: The influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer. 2002;98(3):440-5.
Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-9.
Acloque H, Adams MS, Fishwick K, Bronner-Fraser M, Nieto MA. Epithelial-mesenchymal transitions: The importance of changing cell state in development and disease. J Clin Invest. 2009;119(6):1438-49.
Mani SA, Guo W, Liao MJ, Eaton EN, Ayyanan A, Zhou AY et al. The Epithelial-Mesenchymal Transition Generates Cells with Properties of Stem Cells. Cell. 2008;133(4):704-15.
Noguti J, De Moura CF, De Jesus GP, Da Silva VH, Da Silva VH, Oshima CT et al. M from oral cancer: an overview. CGP. Metastasis from oral cancer: An overview. Cancer Genomics Proteomics. 2012;9(5):329‐35.
Geum D-H, Roh Y-C, Yoon S-Y, Kim HG, Lee JH, Song JM, et al. The impact factors on 5-year survival rate in patients operated with oral cancer. J Korean Assoc Oral Maxillofac Surg. 2013;39(5):207.
Saharinen P, Tammela T, Karkkainen MJ, Alitalo K. Lymphatic vasculature: development, molecular regulation and role in tumor metastasis and inflammation. Trends Immunol. 2004;25(7):387-95.
Padera TP, Kadambi A, Di Tomaso E, Carreira CM, Brown EB Boucher Y et al. Lymphatic metastasis in the absence of functional intratumor lymphatics. Sci. 2002;296(5574):1883-6.
Bhattacharjee A, Chakraborty A, Purkaystha P. Prevalence of head and neck cancers in the north east-An institutional study. Indian J Otolaryngol Head Neck Surg. 2006;58(1):15-9.
Mehrotra R, Singh M, Kumar D, Pandey AN, Gupta RK, Sinha US. Age specific incidence rate and pathological spectrum of oral cancer in Allahabad. Indian J Med Sci. 2003;57(9):400-4.
Brandizzi D, Gandolfo M, Velazco ML, Cabrini RL, Lanfranchi HE. Clinical features and evolution of oral cancer: A study of 274 cases in Buenos Aires, Argentina. Med Oral Patol Oral Cir Bucal. 2008;13(9):E544-8.
Zheng M, Jiang Y, Chen W, Li Kd, Liu X, Gao Sy et al. Snail and Slug collaborate on EMT and tumor metastasis through miR-101-mediated EZH2 axis in oral tongue squamous cell carcinoma. Oncotarget. 2015;6(9):6794–6810.
Kurioka K, Wato M, Iseki T, Tanaka A, Morita S. Differential expression of the epithelial mesenchymal transition factors Snail, Slug, Twist, TGF-β, and E-cadherin in ameloblastoma. Med Mol Morphol. 2017;50(2):68-75.
Tang Y, Liang X, Zhu G, Zheng M, Yang J, Chen Y. Expression and importance of zinc-finger transcription factor Slug in adenoid cystic carcinoma of salivary gland. J Oral Pathol Med. 2010;39(10):775-80.
Franklyn J, Janakiraman R, Tirkey AJ, Thankachan C, Muthusami J. Oral verrucous carcinoma: Ten year experience from a Tertiary Care Hospital in India. Indian J Med Paediatr Oncol. 2017;38(4):452-5.
