Prognostic impact of lymph node micrometastasis in oral and oropharyngeal squamous cell carcinomas

Enhancing oral squamous cell carcinoma prediction: the prognostic power of the worst pattern of invasion and the limited impact of molecular resection margins

Objective

Oral squamous cell carcinoma (OSCC) originates from the mucosal lining of the oral cavity. Almost half of newly diagnosed cases are classified as advanced stage IV disease, which makes resection difficult. In this study, we investigated the pathological features and mutation profiles of tumor margins in OSCC.

Methods

We performed hierarchical clustering of principal components to identify distinct patterns of tumor growth and their association with patient prognosis. We also used next-generation sequencing to analyze somatic mutations in tumor and marginal tissue samples.

Results

Our analyses uncovered that the grade of worst pattern of invasion (WPOI) is strongly associated with depth of invasion and patient survival in multivariable analysis. Mutations were primarily detected in the DNA isolated from tumors, but several mutations were also identified in marginal tissue. In total, we uncovered 29 mutated genes, mainly tumor suppressor genes involved in DNA repair including BRCA genes; however none of these mutations significantly correlated with a higher chance of relapse in our medium-size cohort. Some resection margins that appeared histologically normal harbored tumorigenic mutations in TP53 and CDKN2A genes.

Conclusion

Even histologically normal margins may contain molecular alterations that are not detectable by conventional histopathological methods, but NCCN classification system still outperforms other methods in the prediction of the probability of disease relapse.

High expression of CMTM6 is a risk factor for poor prognosis of gastrointestinal tumors: A meta-analysis

Previous research on the link between CMTM6 expression dysregulation and tumor prognosis has been conflicting. In this study, the predictive effect of CMTM6 in malignant tumors was carefully evaluated using meta-analysis. The literature on the relationship between CMTM6 expression level and malignant tumor prognosis was searched in PubMed, Medline, Embase, and Web of Science databases until April 2021. Data were extracted from eligible studies and analyzed using RevMan5.3 and STATA 12.0 software. The HR and 95%CI were used to analyze the link between CMTM6 expression and OS. And the correlation between CMTM6 expression and clinicopathological features LNM and DM was evaluated by OR and 95%CI. Literature screening eventually included 12 studies involving 2133 patients with malignant tumors. High CMTM6 expression was found to be strongly linked with shorter OS and PFS in cancer patients (HR = 1.84,95%CI: 1.28-2.63, P = 0.001). High CMTM6 expression in gastrointestinal cancers was found to be significantly related with a shorter OS (HR = 2.21, 95%CI: 1.75-2.78, P 0.001). PFS was observed to be related with high CMTM6 expression in cancer patients (HR = 2.029, 95%CI: 1.263-3.26, P = 0.003). Meanwhile, high CMTM6 expression was highly associated to LNM (OR = 1.64, 95%CI: 1.02-2.64, P = 0.043) and DM (OR = 4.07, 95%CI: 1.73-9.56, P = 0.001). However, the expression level of CMTM6 in non-gastrointestinal tumors was not statistically significant with OS or LNM. High CMTM6 expression in gastrointestinal cancers is linked to shorter OS and PFS, as well as LNM and DM, suggesting that high CMTM6 expression could be employed as a new diagnosis for poor prognosis and metastasis.

Attempting to define sentinel node micrometastasis in oral squamous cell carcinoma

OBJECTIVE

The aim of this supplemental study of a sentinel node (SN) biopsy (SNB) trial for oral squamous cell carcinoma (OSCC) was to assess the effectiveness in identifying micrometastasis and determining whether elective neck dissection (END) is necessary.

MATERIALS AND METHODS

Twenty-three patients with pathologically positive SNs were included. The sizes of the metastatic lesions in positive SNs (SMSNs) were classified and the rates of occult metastasis of non-SNs were compared.

RESULTS

The patients were divided according to the SMSN:<0.2 mm (group A, n=3);0.2 mm to <2.0 mm (group B, n=7);and ≥2.0 mm (group C, n=13). The rates of occult metastasis in groups A, B, and C were 0% (0/3), 14% (1/7) and 23% (3/13), respectively.

CONCLUSION

Rare cancer cell distribution to nodes other than SNs was observed in the patients with SN metastatic lesions of at least smaller than 0.2 mm in size, suggesting the possibility of defining SN micrometastasis in N0 OSCC.

Preclinical Assessment of the Effectiveness of Magnetic Resonance Molecular Imaging of Extradomain-B Fibronectin for Detection and Characterization of Oral Cancer

PURPOSE

Oral squamous cell carcinoma (OSCC) has not seen a substantial improvement in patient survival despite therapeutic advances, making accurate detection and characterization of the disease a clinical priority. Here, we aim to demonstrate the effectiveness of magnetic resonance imaging (MRI) with the targeted MRI contrast agent MT218 specific to extradomain-B fibronectin (EDB-FN) in the tumor microenvironment for detection and characterization of aggressive OSCC tumors.

PROCEDURES

EDB-FN expression was evaluated in human normal tongue and OSCC specimens with immunohistochemistry. Invasiveness of human CAL27, HSC3, and SCC4 OSCC cells was analyzed with spheroid formation and transwell assays. EDB-FN expression in the cells was analyzed with semiquantitative real-time PCR, western blotting, and a peptide binding study with confocal microscopy. Contrast-enhanced MRI with MT218 was performed on subcutaneous OSCC mouse models at a dose of 0.04 mmol/kg, using gadoteridol (0.1 mmol/kg) as a control.

RESULTS

Strong EDB-FN expression was observed in human untreated primary and metastatic OSCC, reduced expression in treated OSCC, and little expression in normal tongue tissue. SCC4 and HSC3 cell lines demonstrated high invasive potential with high and moderate-EDB-FN expression, respectively, while CAL27 showed little invasive potential and low-EDB-FN expression. In T₁-weighted MRI, MT218 produced differential contrast enhancement in the subcutaneous tumor models in correlation with EDB-FN expression in the cancer cells. Enhancement in the high-EDB-FN tumors was greater with MT218 at 0.04 mmol/kg than gadoteridol at 0.1 mmol/kg.

CONCLUSIONS

The results suggest EDB-FN has strong potential as an imageable biomarker for aggressive OSCC. MRMI results demonstrate the effectiveness of MT218 and the potential for differential diagnostic imaging of oral cancer for improving the management of the disease.

Prognostic value of long non-coding RNA ZEB1-AS1 in Chinese cancer patients: A Meta-analysis

BACKGROUND

Aberrant expression of long non-coding RNA Zinc finger E-box binding homeobox 1 antisense 1 (lncRNA ZEB1-AS1) can be detected in numerous malignancies. Therefore, a meta-analysis had been carried out in this study, aiming to examine the prognostic value of lncRNA ZEB1-AS1 in malignancies.

METHODS

Electronic databases, such as PubMed, OVID as well as Web of Science, had been systemically retrieved from inception to February 14th, 2019. Besides, the hazard ratios (HRs), together with the corresponding 95% confidence intervals (CIs), had also been analyzed for determining the association of lncRNA ZEB1-AS1 expression with the overall survival (OS) and recurrence-free survival (RFS). In addition, the pooled odds ratios (ORs) would also be computed using the Stata SE12.0 software for evaluating the relationship of lncRNA ZEB1-AS1 expression with pathological factors.

RESULTS

A total of 21 original studies involving 1801 cancer patients had been enrolled into the current meta-analysis. As suggested by the pooled HR, high expression of lncRNA ZEB1-AS1 had displayed marked correlation with OS (HR = 2.16, 95% CI: 1.89-2.47) among cancer patients, and no significant heterogeneity was detected. Additionally, high expression of lncRNA ZEB1-AS1 was also markedly associated with RFS among cancer patients (pooled HR = 2.55, 95% CI: 1.61-4.03). Besides, the expression of lncRNA ZEB1-AS1 had displayed marked correlation with poor histological grade (PHG) (OR = 2.86, 95% CI: 2.11-3.87), high tumor stage (HTS) (OR = 3.81, 95% CI: 2.72-5.34) as well as lymph node metastasis (LNM) (OR = 3.33, 95% CI: 2.47-4.49). Additionally, no distinct asymmetry had been detected for RFS, PHG as well as HTS based on Begg funnel plot.

CONCLUSIONS

Taken together, high expression of lncRNA ZEB1-AS1 can predict the dismal OS, RFS, LNM, PHG, and HTS, indicating that lncRNA ZEB1-AS1 can be potentially used as a new biomarker to predict the dismal prognosis for cancer patients.

Postoperative radiotherapy is dispensable for OSCC patients with micrometastases in lymph nodes

Lymph node metastasis is a decisive factor for performing postoperative radiotherapy for oral squamous cell carcinoma (OSCC). However, whether OSCC patients with only micrometastasis need postoperative radiotherapy is unclear. In this study, OSCC patients (n = 311) with negative (n = 247), only micrometastasis (n = 44) and macrometastasis (n = 20) were detected and selected by HE staining. Micrometastasis was re-assessed using immunohistochemical staining of cytokeratin (CK) in HE-negative patients to find out the false negative cases. The results indicated that, among the negative lymph node cases (n = 247), the positive rate of CK was 4.94% (n = 12). Besides, the clinical features of the primary tumor in relation to the only micrometastatic status and the value of the postoperative radiotherapy on the only micrometastasis patients were evaluated. Patients with only micrometastasis had higher T stage and inferior worst pattern of invasion (WPOI) than patients without micrometastasis, but they had longer overall survival (OS), metastasis-free survival (MFS), and disease-free survival (DFS) than macrometastasis patients. However, the survival time of only micrometastasis patients with or without postoperative radiotherapy was comparable, even in patients with inferior WPOI. Radiotherapy, however, may only benefit patients with IV/V levels of micrometastasis. These data indicated that postoperative radiotherapy is dispensable for only micrometastasis OSCC patients.

BRAF-activated lncRNA predicts gastrointestinal cancer patient prognosis: a meta-analysis

BRAF activated non-coding RNA (BANCR) is often dysregulated in cancer. We performed a meta-analysis to clarify its functions as a prognostic indicator in malignant tumors. We searched the PubMed, Medline, OVID, Cochrane Library, and Web of Science databases to identify BANCR-related studies. Nine original studies and 898 total patients were included in the meta-analysis. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted from the included studies to determine the relationship between BANCR expression and patient overall survival (OS). Odds ratios (OR) were calculated using RevMan 5.3 software to assess associations between BANCR expression and pathological parameters. High BANCR expression correlated with lymph node metastasis (LNM) (OR = 3.41, 95% CI: 1.82-6.37, P = 0.0001), distant metastasis (DM) (OR = 2.98, 95% CI: 1.76-5.07, P < 0.0001), tumor stage (OR = 3.11, 95% CI: 1.89-5.12, Z = 3.25, P < 0.0001), and poor OS (pooled HR = 1.98, 95% CI: 1.20-3.27, P = 0.008) in gastrointestinal (GI) cancer patients, but not in non-GI cancer patients. Our results support the notion that BANCR as a promising prognostic biomarker in Chinese patients with GI cancer.

The microRNA miR-10b as a potentially promising biomarker to predict the prognosis of cancer patients: a meta-analysis

Background

Reported studies on carcinoma have evaluated the significance of the microRNA miR-10b in the development and progression of many cancers. Increased expression of miR-10b is associated with the susceptibility to lymph node metastasis and distant metastasis in various tumors.

Results

The results of the meta-analysis revealed that lymph node metastasis occurred more frequently in the patients group with high expression level of miR-10b than in the patients group with low expression level of miR-10b (OR=4.65, 95% CI: 3.40-6.37, P <0.00001, fixed-effects model). Additionally, a similar result was observed in the association between miR-10b expression and distant metastasis (OR=2.70, 95% CI: 1.79-4.08, P <0.00001, fixed-effects model).

Materials and Methods

In this study, a meta-analysis, including the majority of the relevant articles, was conducted to investigate the association of the miR-10b expression level with metastasis in cancer patients. Systematic literature retrieval was performed by searching in a number of electronic databases. The meta-analysis was conducted using the RevMan 5.2 software and Stata SE12.0 software. A total of 962 patients with carcinoma from 9 studies were included in analysis.

Conclusions

This meta-analysis demonstrated that the overexpression of miR-10b was significantly correlated with metastasis status, and indicated the potential clinical use of miR-10b as a molecular biomarker, particularly in assessing prognosis for patients with cancers.

Long non-coding RNA HULC as a potential prognostic biomarker in human cancers: a meta-analysis

Since the long non-coding RNA HULC (Highly Upregulated in Liver Cancer) is dysregulated in many cancers, we performed a meta-analysis to determine its prognostic potential in malignant tumors. We searched electronic databases, including PubMed, Medline, OVID, Cochrane Library and Web of Science from inception until August 14, 2016 and identified seven studies with 730 cancer patients for the meta-analysis. We analyzed the hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the relationship between HULC expression and overall survival (OS). We also using RevMan5.3 software to calculate odds ratio (ORs) to assess the association between HULC expression and pathological parameters, including lymph node metastasis (LNM), distant metastasis (DM) and the tumor stage. Our analysis showed that higher HULC expression was associated with OS (HR= 0.50, 95% CI: 0.35-0.70, P <0.00001), LNM (OR=0.20, 95 % CI 0.06-0.64), DM (OR=0.27, 95% CI: 0.13-0.54) and the tumor stage (OR=0.39, 95 % CI 0.25-0.64). These meta-analysis data demonstrate that higher HULC expression can be a useful prognostic biomarker in human cancers.

Long non-coding RNA TUG1 as a potential prognostic biomarker in human cancers: a meta-analysis

LncRNA taurine upregulated gene 1 (TUG1) is reportedly dysregulated in various cancers. We performed this meta-analysis to clarify the usefulness of TUG1 as a prognostic marker in malignant tumors. The PubMed, Medline, OVID, Cochrane Library, and Web of Science databases were searched from inception to Jan 11, 2017. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to explore the relationship between TUG1 expression and overall survival (OS). Odds ratios (ORs) were calculated to assess the association between TUG1 expression and pathological parameters. Thirteen original studies covering 1,274 cancer patients were included in this meta-analysis. The pooled HR suggested that high TUG1 expression correlated with poor OS (pooled HR=1.41, 95% CI: 1.01-1.98) in cancer types other than non-small cell lung cancer. TUG1 expression was also related to distant metastasis (OR=3.24, 95% CI: 1.18-8.93), large tumor size (OR=4.07, 95% CI: 1.08-15.28) and advanced tumor stage (OR=3.45, 95% CI: 2.19-5.44). Begg’s funnel plot and Egger’s test showed no evidence of obvious asymmetry for overall survival or tumor stage. Thus high TUG1 expression appears predictive of poor OS, distant metastasis, advanced tumor stage and large tumor size. This suggests TUG1 expression could serve as a biomarker for poor prognosis in cancers.

Long noncoding RNA activated by TGF-β in human cancers: A meta-analysis

BACKGROUND

Because long non-coding RNA ATB (activated by TGF-β) is dysregulated in many cancers, we performed a meta-analysis to determine its prognostic potential in malignant tumors.

METHODS

We searched electronic databases, including PubMed, Medline, OVID, Cochrane Library and Web of Science from inception until November 15, 2016 and identified eight studies with 818 cancer patients for the meta-analysis. We analyzed the hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the relationship between lncRNA-ATB expression and overall survival (OS), recurrence -free survival (RFS), disease-free survival (DFS). We also use RevMan5.3 software to calculate odds ratio (ORs) to assess the association between lncRNA-ATB expression and pathological parameters including lymph node metastasis (LNM), distant metastasis (DM) and tumor stage.

RESULTS

Our analysis showed that increased lncRNA-ATB expression was associated with OS (HR=2.82, 95% CI:1.98-4.00, P<0.00001), DFS (HR=2.75, 95% CI:1.73-4.38, P<0.0001), RFS(HR=3.96, 95% CI:2.30-6.81, P<0.00001), LNM (OR=4.07, 95% CI 1.74-9.53, P=0.001), DM (OR=3.21, 95% CI 1.06-9.72, P=0.04) and high tumor stage (OR=2.81, 95% 1.78-4.43, P<0.0001) in patients with other types of cancers that excluded pancreatic cancer.

CONCLUSIONS

Meta-analysis demonstrated that increased lncRNA-ATB expression can be a useful prognostic biomarker in human cancer.

Cervical Metastases Behavior of T1-2 Squamous Cell Carcinoma of the Tongue

INTRODUCTION

The cervical lymph node metastasis (CM) is one of the most important prognostic factors for oral squamous cell carcinoma. Although the frequency and distribution of CM for tongue carcinoma (TC) are well documented in the literature, there is only little data on metastasis patterns depending on the location of the cancer within the tongue.

MATERIALS AND METHODS

In a retrospective study all patients with a T1-T2 TC who were treated between 1997 and 2013 were analysed regarding epidemiological data, risk factors, and tumour parameters such as exact localization, CM.

RESULTS

204 patients (59 ± 15 years; ♀37 %, ♂63 %) were included. At the initial diagnosis 23 % had an advanced tumour stage (III-IV) due to CM. The occurrence of CM was significantly higher for T2, advanced G-status and the localization in the posterior area of the tongue. The presence of CM-but not the recurrence-had a significant influence on the survival rate.

CONCLUSION

The small TC has an aggressive metastatic behaviour depending not only on the classical prognostic factors such as grading and tumour size, but is also strongly influenced by the posterior location within the tongue.

HOXB7 as a promising molecular marker for metastasis in cancers: a meta-analysis

Numerous studies on carcinoma have revealed that the expression level of HOXB7 in cancerous tissues was significantly higher than that in noncancerous tissues. Elevated expression of HOXB7 is associated with the susceptibility to lymph node metastasis and distant metastasis in various tumors. In this study, a meta-analysis was performed to involve majority of relevant articles and explore the association of HOXB7 expression level with metastasis in cancer patients. Literature retrieval was conducted by searching in a number of electronic databases (up to December 1, 2015). The meta-analysis was conducted with RevMan 5.3 software and Stata SE12.0. A total of 1,532 patients with carcinoma from 14 studies were included in analysis. The results of meta-analysis demonstrated that lymph node metastasis was observed more frequently in the patients group with high expression level of HOXB7 than in the patients group with low expression level of HOXB7 (odds ratio =2.17, 95% CI: 1.74–2.71, P<0.00001, fixed-effects model). In addition, a similar result was observed in the association between HOXB7 expression and distant metastasis; the odds ratio was 1.77 (95% CI: 1.09–2.88, P=0.02, fixed-effects model). This meta-analysis demonstrated that the overexpression of HOXB7 was significantly associated with metastasis in cancer patients, which may be served as a common molecular marker for indicating cancer metastasis.