Predictive markers for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral tongue

[Systematic neck dissection in squamous cell carcinoma of the oral cavity]

OBJECTIVES

To evaluate the neck control after prior surgical management of patients with squamous cell carcinoma of the oral cavity and to quantify the ratio of patients among whom neck dissection did not have a real therapeutic value. To discuss the usefulness of the sentinel node biopsy in this group of patients.

METHOD

Retrospective analysis of patients with epidermoid carcinoma of the oral cavity who had systematically a neck dissection.

RESULTS

Thirty-nine files of patients have been processed. We found 45% patients classified pN0 (among whom about one half where classified pT4). With a mean follow-up of 19 months, we did not find any cervical lymph node relapse. Five patients died (13.5%) without any cervical disease.

CONCLUSION

The systematic cervical lymph node dissection remains the most effective means to obtain the neck control of squamous cell cancers of the oral cavity. It however was applied without therapeutic value for 45% of the patients of this series. The validation of the sentinel node concept as a method of cervical staging should make it possible to avoid this surgical procedure in more than one third of the cases.

Expression of E-cadherin in cervical lymph nodes from primary oral squamous cell carcinoma patients

BACKGROUND

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in oral and maxillofacial region with poor prognosis. E-cadherin plays a key role in cell-to-cell adhesion. E-cadherin expression in the metastatic cervical lymph node, especially in the micrometastatic cervical lymph node has seldom been reported in OSCC patients.

OBJECTIVE

To investigate the E-cadherin expression in cervical lymph nodes from OSCC patients as well as its clinical significance.

DESIGN

Thirty-three OSCC patients were involved in this study; among them, there were 28 males and 5 females, the age ranged from 34 to 78 years (mean 58.8 years). The most suspicious metastatic cervical lymph node (total 99 lymph nodes) from three cervical regions of each OSCC patient was selected for detection of E-cadherin using routine pathological examination and immunohistochemistry.

RESULTS

Increased E-cadherin expression in the metastatic cervical lymph nodes was detected, which was diagnosed by routine pathological examination using HE staining. However, in the micrometastatic cervical lymph node, E-cadherin expression was negative. The survival rate of OSCC patients correlated with decreased E-cadherin expression (P=0.001), N stage (P=0.024) and tumor recurrence (P<0.001). Tumor recurrence is the only independent factor on the prognosis (RR=20.83 and P=0.014).

CONCLUSIONS

Decreased E-cadherin expression in cancerous tissue correlates with the poor prognosis of OSCC patients. Detection of E-cadherin expression is useful to confirm the cervical lymph node metastasis and maybe useless to detect the cervical lymph node micrometastasis; further studies are encouraged to reveal the detail mechanism of E-cadherin expression in formation of lymph node metastatic focus.

Molecular biology of oral cavity squamous cell carcinoma

Significant advances have been made in understanding the mechanisms that contribute to carcinogenesis in OCSCC. This progress has led to the development of therapeutic strategies that target dysregulated processes in the tumor microenvironment (Fig. 11) [72]. The introduction of angiogenesis inhibitors, growth factor receptor tyrosine kinase inhibitors, and cell cycle regulators into clinical trials for the management of OCSCC has resulted from the great strides made in the understanding of tumor biology. It is important for those caring for patients who have OCSCC to have a firm background in tumor biology, because many future therapies will be based on this complex panorama of cellular physiology.

Regional difference in intratumoral lymphangiogenesis of oral squamous cell carcinomas evaluated by immunohistochemistry using D2-40 and podoplanin antibody: an analysis in comparison with angiogenesis

BACKGROUND

Whether tumor cells induce lymphangiogenesis intratumorally or permeate pre-existing lymphatic vessels in the peritumoral area still remains unclear. In this study, we investigated in detail the intratumoral lymphangiogenesis of oral squamous cell carcinomas (SCC) in comparison with tumor angiogenesis.

METHODS

Immunohistochemistry with D2-40, podoplanin antibody, and CD34 antibody were used to evaluate the lymphatic vessel density (LVD) and blood microvessel density (MVD). Vascular endothelial growth factor (VEGF) and VEGF-C expressions of oral SCC were also assessed by immunohistochemistry.

RESULTS

LVD significantly increased in the superficial area of tumor tissue compared with normal mucosa, whereas it decreased in the deep area of intratumoral tissue near the invasion front, in sharp contrast to MVD, which significantly increased throughout tumor tissue. Consistent with the decreased intratumoral LVD and increased intratumoral MVD, VEGF-C expression of tumor cells was down-regulated in the deep area of tumor tissue, while VEGF expression of tumor cells was up-regulated throughout the tumor tissue.

CONCLUSIONS

Lymphangiogenesis in oral SCC varies depending on the region within the tumor tissue. It is not induced in the genuine tumor stroma near the invasion front, probably due to the down-regulation of VEGF-C expression of tumor cells, which is different from VEGF-mediated induction of intratumoral angiogenesis.

[MUC1 (EMA): A key molecule of carcinogenesis?]

MUC1 is a large trans-membrane highly glycosylated mucin which is expressed at the apical pole of normal cells in glandular epithelia. MUC1 is implicated in many physiological mechanisms such as adhesion, development and differentiation. Also, MUC1 is frequently deregulated and over-expressed with a membrane circumferential and/or cytoplasmic expression. The intracellular tail of MUC1 is phosphorylated and can interact with many signalling proteins and transcriptional factors. Indeed, MUC1 can interact with B-catenin competitively for E-cadherin, thus destabilizing intercellular junctions and favouring metastatic dissemination. In carcinomas, the overexpression and membrane delocalization of MUC1 is associated with a worse prognosis and a shorter survival in breast, colon, kidney, prostate or gastro-intestinal cancers. MUC1 appears to be a novel therapeutic target for immunotherapy or anti-tumour vaccines.

Differential expression of E-cadherin in metastatic lesions comparing to primary oral squamous cell carcinoma

BACKGROUND

The main cause of treatment failure in resectable oral squamous cell carcinoma (OSCC) is metastasis. E-cadherin (E-cad) plays a principal role in cell adhesion and motility, and is associated with OSCC progression. The aim of this study was to investigate the clinical significance of E-cad expression in OSCC with lymph node metastasis which had radical neck dissection done.

METHOD

Immunohistochemistry was used to detect E-cad expression in normal oral mucosa (NOM) (n = 10), oral precancerous lesions (OPLs) (n = 20), primary OSCC (n = 45), and their paired metastatic lesions (n = 45). E-cad immunoreactivity correlated with the clinicopathologic features.

RESULTS

E-cadherin immunoreactivity was progressively reduced in the NOM followed by OPLs and primary OSCC (58%). It decreased significantly in the advanced stages of OSCC. However, the increase in E-cad immunoreactivity was observed in the majority (60%) of metastatic lesions in relation to primary OSCC. Patients with such increased or positive immunoreactivity of E-cad in metastatic lesions exhibited worse prognosis.

CONCLUSION

The findings suggested a dynamic change in E-cad immunoreactivity during tumorigenesis and metastasis of OSCC. In a multivariate analysis, E-cad immunoreactivity in metastasis lesions (odds ratio 3.74, 95% CI 1.15-14.67; P = 0.040) implied the potential role of mortality predictors for OSCC cases with nodal involvement.

Management of the Patients with Early Stage Oral Tongue Cancers

The incidence of oral cancer is increasing all over the world and tongue cancer is the most common type of oral cancer. However, standard treatment strategy for early stage tongue cancer has not yet been determined. To assess the appropriate therapy including elective neck dissection, a retrospective chart review of the patients were performed. Thirty-one patients with T1 or T2 tongue carcinomas were surgically treated in our hospital from 2001 through 2005. Twenty-one out of these patients were diagnosed as N0 by physical and diagnostic examinations. Three of 6 patients with T2N0 tumors who had undergone only partial glossectomy had recurrent tumors in the neck and died of disease. The disease-free survival rates at 40 months by Kaplan-Meier analysis were 100% and 60% for T1N0 and T2N0 patients, respectively, with a median follow-up time of 27 months for surviving patients. The depth of the tumor invasion and diameter of the tumors were analyzed. There was a significant difference between the frequency of nodal metastasis in patients with tumor less than 4 mm in depth and patients with tumors more than 4 mm in depth. These data indicate that elective neck dissection should be considered for treating patients with T2N0 tongue cancer because of the poorer prognosis of the patients if they did not undergo elective neck dissection, and that the depth of the tumor invasion is a critical factor for lymph node metastasis and preoperative evaluation of it might be an effective tool for the selection of the therapy.

Beta-catenin and E-cadherin expression in salivary gland tumors

This study evaluated the expression of E-cadherin and beta-catenin in salivary gland tumors. Twelve biopsy specimens from cases diagnosed as pleomorphic adenoma, 17 adenoid cystic carcinomas, 10 epithelial-myoepithelial carcinomas, and 4 polymorphous low-grade adenocarcinomas were immunohistochemically labeled for E-cadherin and beta-catenin antibodies. Healthy salivary glands were used as controls. Membrane-associated E-cadherin and beta-catenin expression was present in all the tumor types studied. E-cadherin and beta-catenin showed a similar distribution; however, beta-catenin labeling was weaker than that for E-cadherin. In the epithelial-myoepithelial carcinomas, myoepithelial cells exhibited diffuse nuclear staining, although occasional cells presented only focal labeling. Epithelial-myoepithelial carcinomas present changes in [.beta]-catenin expression but the other salivary tumors studied do not, which may reflect divergence in tumorigenesis of this extensive subset of salivary gland tumors.

Good tumor control and survivals of squamous cell carcinoma of buccal mucosa treated with radical surgery with or without neck dissection in Taiwan

The aim was to analyze the survival and prognostic factors in 232 patients with squamous cell carcinoma of the buccal mucosa (BSCC) treated with radical surgery with or without neck dissection (ND). The 5-year survivals for local, locoregional control, overall, disease-free, and disease-specific were demonstrated. Pathologic nodal status was the independent risk factor for local and locoregional control. Both pathologic nodal status and cell differentiation were the significant prognostic factors of disease-free survival. For cT1N0, 11.1% had neck metastases. All were tumor depth of > or =6 mm. Our result showed a relatively better tumor control and survivals in BSCC with radical surgery with or without ND. The possible reason may be due to the benefit from widely surgical resection with ND and post-operative radiotherapy or concurrent chemoradiotherapy in those with risk factors. In treating early cT1N0, we suggest that elective ND is indicated only when tumor depth > or =6 mm.

Snail-dependent and -independent Epithelial-Mesenchymal Transition in Oral Squamous Carcinoma Cells

Disappearance of E-cadherin is a milestone for epithelial-mesenchymal transition (EMT), found both in carcinomas and in some fibrotic diseases. We have studied the mechanisms of EMT in oral squamous cell carcinoma (SCC) cells isolated from primary tumor (43A) and its recurrent tumor (43B). Whereas the cells from primary carcinoma displayed a typical phenotype of squamous epithelial cells including E-cadherin and laminin-332 (laminin-5), cells from recurrent tumor expressed characteristics of dedifferentiated, EMT-experienced tumors. 43B cells expressed E-cadherin repressors ZEB-1/δEF1 and especially ZEB-2/SIP1, which therefore appear as candidates for endogenous EMT in these cells. Differences between endogenous and exogenous EMT were assessed by transfecting 43A cells with SNAIL cDNA. SNAIL-transfected cells showed complete EMT phenotype with fibroblastoid appearance, vimentin filaments, E-cadherin/N-cadherin switch, lack of hemidesmosomes and, as a new feature of EMT, lack of laminin-332 synthesis. Upregulation of ZEB-1 and ZEB-2 was evident in these cells, suggesting that SNAIL can regulate these E-cadherin repressors. New monoclonal antibodies against SNAIL showed nuclear immunoreactivity not only in the SNAIL-transfected cells but also in carcinoma cells lacking production of Lm-332 and showing signs of EMT. These results suggest that changes in the epithelial cell differentiation program and EMT in SCC cells can result from the interplay among several E-cadherin repressors; however, SNAIL alone is able to accomplish a complete EMT. (J Histochem Cytochem 54:1263-1275, 2006)

Activation of ERK1/2 and cyclin D1 expression in oral tongue squamous cell carcinomas: Relationship between clinicopathological appearances and cell proliferation

We report an immunohistochemical investigation of the expression of activated extracellular signal-regulated kinase (ERK1/2) and cyclin D1 protein in both oral tongue squamous cell carcinomas (OTSCCs) and normal tongue epithelium. The expression of Ki-67 labeling index (LI) was also examined in order to evaluate cell proliferation activity. The expression of activated ERK1/2, cyclin D1 protein and Ki-67 LI were significantly stronger in OTSCCs than in normal oral mucosa (P<0.05). Both over-expression of activated ERK1/2 and positive expression of Ki-67 in OTSCCs were significantly associated with a moderately or poorly differentiated grade of carcinoma (P<0.05). Cyclin D1 immunostaining showed statistically significant association with both lymph node metastasis (P<0.05) and a tumor thickness >5mm (P<0.05). Over-expression of activated ERK1/2 was positively correlated with cyclin D1 protein expression (P<0.05, r=0.624) and cell proliferation-related indexes Ki-67 (P<0.05, r=0.723). Our results suggest that over-expression of activated ERK1/2 and cyclin D1 protein are involved in oral tongue carcinogenesis, and that activation of ERK1/2 might be related to cell cycle regulation and cell proliferation in OTSCCs.

Carcinoma of tongue and the buccal mucosa represent different biological subentities of the oral carcinoma

PURPOSE

Clinico-epidemiological studies show that the behaviour of the tongue cancer is different from the cancer originating at other sites of the oral cavity. However, studies identifying the reason for such difference are lacking in the literature.

METHODS

In the present study, we have attempted to see whether any difference existed in the cell cycle regulatory mechanism of these tumours by comparing immunohistochemically the expression of major cell cycle regulatory proteins in 147 buccal and 94 tongue carcinoma (anterior two-third of tongue) prospectively.

RESULTS

On comparison of buccal and tongue carcinoma, expression of p16 and p21 showed significant difference. In combined analysis, simultaneous down regulation of p16 and p21 was seen in 47% of tongue cancer cases as against 28% in buccal carcinoma (P=0.004). In univariate analysis, none of the clinico-biological variables studied showed significant association with survival in tongue carcinoma, whereas, some of the clinico-biological variables associated with survival in buccal carcinoma. Among the biological markers, the overexpression of cyclin D1 (P=0.007) and p53, detected using both the clones of antibodies-DO7 (P=0.008) and PAb240 (P=0.014) and the down regulation of p16 (0.033), showed significant association with shorter disease free survival (DFS) in these cases. Whereas in the case of overall survival (OS), overexpression of p53 [DO7 (P=0.031) and PAb240 (P=0.017)] and cyclin D1 (P=0.001) associated with poor survival. In multivariate analysis, the expression pattern of p53 and p16 protein influences the DFS whereas cyclin D1 expression showed independent association with the OS in buccal carcinoma.

CONCLUSIONS

Thus, tongue and buccal cancers represent different biological subentities, and such differences should be considered in oral cancer management.

Aberrant expression of β- and γ-catenin is an independent prognostic marker in oral squamous cell carcinoma

Alteration in expression of E-cadherin and catenins is associated with loss of differentiation, acquisition of an invasive phenotype and poor clinical outcome in many types of cancer. To identify molecular prognostic markers, membrane expression levels of E-cadherin, and alpha-, beta- and gamma-catenin in biopsy samples (n=135) of oral squamous cell carcinoma (OSCC) were evaluated immunohistochemically in relation to preoperative tumour-related features, clinical course and prognostic value, and were found to be significantly correlated with an endophytic growth pattern and pathologically proved lymph-node metastasis. Alteration of expression of E-cadherin, and alpha-, beta- and gamma-catenin was also significantly correlated with poor disease-specific 5-year survival (P=0.0096, 0.0434, 0.0005 and 0.0005, respectively). Multivariate Cox proportional hazard regression analysis showed that alteration of beta- and gamma-catenin expression was a significantly independent prognostic parameter for survival (P=0.0112 and 0.0088, respectively), as was the case with endophytic growth pattern and advanced N-category. These results indicate that patients with OSCC and absent or reduced membrane expression of beta- and gamma-catenin should be considered a high-risk group for regional lymph-node metastasis and poor prognosis.

Outcome of preoperative concurrent chemoradiotherapy and surgery for resectable lingual squamous cell carcinoma greater than 3cm: The possibility of less extensive surgery

We present the outcome of treatment with preoperative concurrent chemoradiotherapy and surgery for resectable lingual squamous cell carcinoma more than 3 cm in its greatest dimension. Twenty patients were enrolled in this study between June 2001 and August 2004. Concurrent chemoradiotherapy included intraarterial pirarubicin (THP) (5 mg/day), intravenous continuous 5-FU, and radiation, usually followed by surgery. Complete response rate was 100%. Notably, 8 of 12 patients who underwent surgery exhibited pathologically complete response, though three patients developed recurrence or distant metastasis. The main adverse effects were mucositis (13/20) and leucopenia (9/20), both of which were acceptable. Although long-term results should be considered, our treatment method appears very useful for lingual squamous cell carcinoma greater than 3 cm, with a remarkably high rate of pathological local control and acceptable adverse events.

Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature

BACKGROUND

Oral mucosa squamous cell carcinoma (OSCC) has locoregional evolution, with frequent neck involvement (the most important parameter for prognosis). There are still many doubts concerning the best way to approach N0 neck disease in early-stage lesions (T1 and T2). Many parameters have been studied to identify N0 patients with a high likelihood of harboring occult node metastases or of having them develop.

METHODS

A review of the studies analyzing "tumor thickness"/"depth of invasion" in predicting regional metastases and survival was undertaken.

RESULTS

The literature suggests that "tumor thickness"/"depth of invasion" is a reliable parameter for predicting regional nodal involvement and survival in OSCC.

CONCLUSIONS

Authors are in substantial agreement regarding the reliability of tumor thickness. The lack of comparable study groups, measurement techniques, and cut-off values points to the need for further studies so as to reach a consensus and to develop therapy protocols that include tumor thickness.

The epigenetics of oral cancer

Whilst genetic alterations in oral cancer have long been documented, the appreciation of epigenetic changes is more recent. Epigenetic changes alter expression of tumour suppressor genes without changes in DNA sequence. Epigenetic mechanisms such as DNA methylation, histone methylation and deacetylation have been shown to silence key genes involved in cell proliferation, differentiation and genome integrity, and clearly have a central role in oral cancer. The pattern of hypermethylation in any individual tumour can now be accurately determined, which may find application in molecular staging. In addition, current trials are evaluating the safety and efficacy of agents affecting epigenetic changes in cancer patients which hold some therapeutic promise.

Dysadherin Expression in Head and Neck Squamous Cell Carcinoma

Dysadherin is a recently characterized cancer-associated cell membrane glycoprotein that has a crucial role to cell-cell adhesiveness. The aim of this study was to examine dysadherin expression in head and neck squamous cell carcinoma (HNSCC). A total of 108 tissue specimens of patients with HNSCC were examined using immunostaining for dysadherin, E-cadherin, and the specific lymphatic endothelium marker D2-40. We quantified dysadherin and E-cadherin expression, assessed intratumoral (ILD) and peritumoral lymphatic density (PLD), and examined the possible associations of all the above parameters with clinicopathologic features and outcome. Finally, we used double staining with dysadherin and D2-40 to examine the expression pattern of dysadherin simultaneously with the lymphovasculature environment of HNSCC. High dysadherin expression was correlated with higher clinical stage (chi2, P = 0.01), with the presence of lymph node metastasis at the time of diagnosis (chi2, P = 0.02), and with increased ILD (chi2, P = 0.001). We observed an impressive reverse association between increased dysadherin expression and decreased E-cadherin expression (chi2, P < 0.001). Surprisingly, dysadherin-positive cancer cells usually gathered around areas of high intratumoral lymphatic vessel concentration, surrounding and invading small intratumoral lymphatics. Higher clinical stage and increased dysadherin expression were found to be the only significant independent prognostic factors for overall survival (hazard ratio, 3.94; 95% confidence interval, 1.09-14.27 for clinical stage; hazard ratio, 3.92; 95% confidence interval, 1.46-10.51 for dysadherin). The loss of intercellular adhesiveness and increased dysadherin expression seems to be related to lymphangiogenesis in HNSCC, but this should be confirmed by additional studies. Dysadherin expression might be a promising prognostic marker for separation of patients at higher risk.

Prognostic value of activated Akt expression in oral squamous cell carcinoma

BACKGROUND

Akt is a serine/threonine kinase that plays an important role in tumorigenesis and influences prognosis in several cancers. However, its importance in oral squamous cell carcinomas (OSCC) has not been elucidated.

AIM

To investigate the association between the expression of activated Akt, clinicopathological factors, and E-cadherin, PCNA (proliferating cell nuclear antigen), and VEGF (vascular endothelial growth factor) expression to verify the validity of Akt as a prognostic factor in OSCC.

METHODS

Phosphorylated Akt (p-Akt), E-cadherin, PCNA, and VEGF expression were assessed immunohistochemically in 84 OSCCs. The results were analysed in relation to clinicopathological factors.

RESULTS

p-Akt was expressed in 29 cases. It was significantly correlated with lymph node metastasis, TNM stage, and E-cadherin expression. Univariate analysis showed that p-Akt expression, E-cadherin expression, PCNA expression, differentiation, tumour size, lymph node metastasis, TNM stage, and recurrence correlated with prognosis. Multivariate analysis showed that p-Akt expression is an independent prognostic factor in patients with OSCC.

CONCLUSIONS

This study revealed that Akt activation is a significant prognostic indicator for OSCC and is correlated with E-cadherin expression. The inhibition of Akt is a possible molecular approach to the treatment of OSCC.

Cyclin D1 gene numerical aberration is a predictive marker for occult cervical lymph node metastasis in TNM Stage I and II squamous cell carcinoma of the oral cavity

BACKGROUND

The management of occult cervical lymph node metastases originating from oral squamous cell carcinomas (OSCCs) remains controversial. The purpose of this study was to evaluate the value of cyclin D1 gene (CCND1) numerical aberrations in predicting the risk of late lymph node metastases.

METHODS

Fluorescence in situ hybridization (FISH), using a BAC clone specific for CCND1, was performed on OSCC specimens obtained by fine-needle aspiration (FNA) biopsy from 45 patients with previously untreated TNM Stage I and II (T1-2N0M0) disease who had not undergone elective cervical lymph node dissection.

RESULTS

CCND1 numerical aberrations were observed in 15 (33.3%) of the 45 patients and were significantly associated with the mode of invasion of the primary tumor (P = 0.01) and the presence of occult lymph node metastases (P < 0.001). Twelve of these 15 patients (80%) developed late cervical lymph node metastases within 2 years of surgery for primary OSCCs. All patients with cluster-type amplification of CCND1 developed late lymph node metastases. Multivariate analysis showed that only CCND1 numerical aberrations (risk ratio, 8.685%, 95% confidence interval = 2.232-33.802, P = 0.002) independently predicted late cervical lymph node metastasis.

CONCLUSIONS

Aberrations in CCND1 numbers appear to be valuable in identifying patients at high risk of late lymph node metastasis in Stage I and II OSCCs. Analysis of CCND1 numerical aberrations using FISH on FNA biopsy specimens may be useful in selecting patients for elective cervical lymph node dissection.

Reduced E-cadherin expression is an indicator of unfavourable prognosis in oral squamous cell carcinoma

The aim was to evaluate E-cadherin expression in oral squamous cell carcinoma, and its possible relationships with tumour histology and with clinical course and survival. Surgical biopsies from 47 cases of oral squamous cell carcinoma were analysed for expression of E-cadherin using immunohistochemistry. Statistical analyses were performed to identify possible associations with tumour clinic-histological features and with clinical course and survival. Weak or absent E-cadherin expression was associated with a more invasive histological pattern and with metastasis to the cervical lymph nodes. Uni- and multivariate analyses indicated that weak or undetectable E-cadherin expression is an indicator of shorter disease-free period and shorter survival time. Reduced E-cadherin expression in oral squamous cell carcinoma is associated with more aggressive tumour behaviour and worse prognosis.

Diffuse expression of laminin gamma2 chain in disseminating and infiltrating cancer cells indicates a highly malignant state in advanced tongue cancer

The expression of laminin (LN)gamma2 chain in the primary lesions of 20 patients with advanced tongue cancer was analyzed. Positive expressions of LNgamma2 were noted in all of the primary tissue specimens, however, the expression patterns clearly differed according to the mode of growth and invasion of cancer cells. In tumor nests where cancer cells preserved cell-cell adhesiveness and showed polar differentiation, LNgamma2 was expressed only in the peripheral cells of the tumor nests; peripheral expression. On the other hands when cancer cells diminished their cell-cell adhesiveness and strongly infiltrated through stroma, almost all of the cancer cells diffusely expressed LNgamma2; diffuse expression. The peripheral expression of LNgamma2 were noted in 13 patients and the diffuse expressions were noted in 7 patients. The rates of positive cervical metastases according to the expression type were 7/13 for the peripheral expression and 7/7 for the diffuse expression (p = 0.02). The diseases specific 3-year survival rates for the patients with the peripheral expression and the diffuse expression were 68% and 14%, respectively (p = 0.02). The diffuse expression of LNgamma2 in the disseminating and infiltrating cancer cells might indicate a highly malignant state in advanced tongue cancer. Therefore, a more intensive treatment modality would be necessary for the patients with advanced tongue cancer showing the diffuse LNgamma2 expression.

P-cadherin expression and survival rate in oral squamous cell carcinoma: an immunohistochemical study

BACKGROUND

P-cadherin (P-cad) is a transmembrane molecule involved in the cell-cell adhesion and similar to E-cadherin (E-cad), but less investigated in oncology, especially in in vivo studies. Aims of the present study were to assess the prevalence of P-cad expression in oral squamous cell carcinoma (OSCC) and to verify whether P-cad can be considered a marker of prognosis in patients with OSCC.

METHODS

In a retrospective study, a cohort of 67 OSCC patients was investigated for P-cad expression and its cellular localization by immunohistochemistry; some respective healthy margins of resection were similarly investigated as standard controls. After grouping for P-cad expression, OSCCs were statistically analyzed for the variables age, gender, histological grading (G), TNM, Staging, and overall survival rate. Univariate and multivariate analyses were performed.

RESULTS

37 cases (55.2%) of OSCC showed membranous/cytoplasmic positivity for P-cad, whereas 30 (44.8 %) were negative. Although with some differences in membranous vs cytoplasmic localization of P-cad in OSCC with different G, no statistical association was found between P-cad expression and any variables considered at baseline. In terms of prognostic significance, P-cad non expression was found to have an independent association with poorer overall survival rate than P-cad expressing group (P = 0.056); moreover, among P-cad +ve patients the best prognosis was for those OSCC with membranous (P < 0.0001) than those with cytoplasmic P-cad expression.

CONCLUSION

On the basis of these results, it is possible to suggest P-cad as an early marker of poor prognosis. The abnormal or lack of P-cad expression could constitute an hallmark of aggressive biological behavior in OSCC.

Association of cyclin D1, p16 and retinoblastoma protein expressions with prognosis and metastasis of gallbladder carcinoma

AIM: To investigate the role of cyclin D1, p16 and retinoblastoma in cancerous process of gallbladder carcinomas and to assess the relation between cyclin D1, p16, Rb and the biological characteristics of gallbladder carcinoma.

METHODS: Forty-one gallbladder carcinoma, 7 gallbladder adenoma and 14 chronic cholecystitis specimens were immunohistochemically and histopathologically investigated for the relation of cyclin D1, p16 and Rb with Nevin staging and pathologic grading.

RESULTS: The expression rates of abnormal cyclin D1 in gallbladder carcinoma (68.3%)and gallbladder adenoma(57.1%) were significantly higher than those in chronic cholecystitis (7.1%) (P<0.05). No significant difference was found both among the pathological grades G₁, G₂ and G₃ and among Nevin stagings S₁-S₂, S₃ and S₄-S₅ of gallbladder carcinoma. The positive rates of p16 (48.8%) and Rb (58.5%) in gallbladder carcinoma were significantly lower compared to those in adenoma (100.0%) and cholecystitis (100.0%) (P<0.05). The positive rates of p16 and Rb in Nevin stagings S₁-S₂ (80.0% and 90.0%) and S₃ (46.2% and 61.5%) gallbladder carcinomas were significantly higher than those in S₄-S₅ (33.3% and 38.8%) (P<0.05), and those in pathologic grades G₁ (54.5% and 81.8%) and G₂ (50.0% and 62.5%) gallbladder carcinoma were significantly higher than those in G₃ (28.6% and 35.7%) (P<0.05). The protein expression of p16 and Rb had a negative-correlation in gallbladder carcinoma (r = -0.2993, P<0.05), and this negative-correlation was correlated with Nevin staging (P<0.05). Moreover, the protein expression of p16 and cyclin D1 had a negative-correlation in gallbladder carcinoma (r = -0.9417, P<0.05).

CONCLUSION: Cyclin D1 may play a role in the early stage of gallbladder carcinoma. Mutation of p16 and Rb genes might be correlated with progression of gallbladder carcinoma. Analysis of p16 and Rb can estimate the prognosis of gallbladder carcinoma. Expression of p16 and Rb may be correlated with Nevin staging and pathologic grading in gallbladder carcinoma.

Profiling early head and neck cancer

Head and neck squamous-cell carcinoma (HNSCC) is the sixth most common cancer worldwide and, disappointingly, survival rates are not improving. Moreover, HNSCC has a severe impact on the quality of life of patients and survivors, and the significant morbidity subsequent to treatment often mandates long-term multidisciplinary care, which places significant financial pressures on the treating institution. Therefore, prevention and early diagnosis of high-risk pre-malignant lesions are high priorities for reducing deaths due to head and neck cancer. Recent advances have begun to elucidate the different aetiologies of HNSCCs in relation to previous pre-malignancies and to identify which pre-malignant lesions are likely to progress to malignancy.

Progression of head and neck squamous cell cancer

Squamous cell cancer in the head and neck region (HNSC) is unique concerning its progression since it remains locoregional for long time and visceral metastases develop only in a later stage of the disease. Accordingly, molecular markers of the local invasion and the lymphatic dissemination both have critical importance. HNSC progression is associated with deregulated control of cell proliferation and apoptosis but it seems equally significant the disregulation of the proteolytic machineries. Here we outline the lymphatic metastatic cascade for HNSC to depict key molecular determinants as possible prognostic factors or therapeutic targets identifying immunological selection as a major feature. Unlike in local spreading, invasive potential of cancer cells seems to be less significant during lymphatic dissemination due to the anatomical properties of the lymphatic vessels and tissues. There is a general believe that HNSC is one disease however, data indicate that the anatomical localization of the tumor (the "soil") such as oral, lingual, glottic or pharyngeal has a significant effect on the gene expression profile and corresponding biological behavior of HNSC. Furthermore, even the endocrine milieu of the host was proved to be influential in modulating the progression of HNSC. Gene expression profiling techniques combined with proteomics could help to define and select usefull genetic and biomarkers of progression of HNSC, some of them could well be potential novel therapeutic target.