Development and validation of a 6-gene signature for the prognosis of loco-regional control in patients with HPV-negative locally advanced HNSCC treated by postoperative radio(chemo)therapy

The Role of SOX2 and SOX9 in Radioresistance and Tumor Recurrence

Head and neck squamous cell carcinoma (HNSCC) exhibits considerable variability in patient outcome. It has been reported that SOX2 plays a role in proliferation, tumor growth, drug resistance, and metastasis in a variety of cancer types. Additionally, SOX9 has been implicated in immune tolerance and treatment failures. SOX2 and SOX9 induce treatment failure by a molecular mechanism that has not yet been elucidated. This study explores the inverse association of SOX2/SOX9 and their distinct expression in tumors, influencing the tumor microenvironment and radiotherapy responses. Through public RNA sequencing data, human biopsy samples, and knockdown cellular models, we explored the effects of inverted SOX2 and SOX9 expression. We found that patients expressing SOX2LowSOX9High showed decreased survival compared to SOX2HighSOX9Low. A survival analysis of patients stratified by radiotherapy and human papillomavirus brings additional clinical relevance. We identified a gene set signature comprising newly discovered candidate genes resulting from inverted SOX2/SOX9 expression. Moreover, the TGF-β pathway emerges as a significant predicted contributor to the overexpression of these candidate genes. In vitro findings reveal that silencing SOX2 enhances tumor radioresistance, while SOX9 silencing enhances radiosensitivity. These discoveries lay the groundwork for further studies on the therapeutic potential of transcription factors in optimizing HNSCC treatment.

Key Genes and Endoscopic Radical Surgery in Primary Middle Ear Oncocytic Papillomas

OBJECTIVE

Papillomas originating from the Schneiderian epithelium within the middle ear are extremely rare and may be associated with a high rate of recurrence and malignant transformation. Oncocytic papillomas represent the rarest pathological subtype of such tumors. The current investigation aimed to determine whether there exists a distinct mechanism underlying the incidence of oncocytic papillomas arising primarily within the middle ear, and to explore potential treatment strategies to ensure complete removal and prevent recurrence.

STUDY DESIGN

Search of the English literature for cases of middle ear papilloma and RNA sequencing analysis of three samples from one new case presenting at the Eye and ENT Hospital, Fudan University (Shanghai, China), with recurrent middle ear oncocytic papilloma, along with two normal mucosal samples.

SETTING

Academic, tertiary referral hospital.

PATIENT AND INTERVENTIONS

The patient underwent open mastoidectomy and endoscopic tympanoplasty twice in 6 years. Histopathology confirmed oncocytic papilloma in middle ear. The patient has been free of the disease at 18 months of follow-up without radiation, whereas the RNA-seq analysis of the samples in endoscopic operations remained nonmalignant.

RESULTS

Only four cases of primary middle ear oncocytic papillomas have been reported. Recurrent masses usually originate from around the eustachian tube, which may explain the pathogenesis of this lesion. RNA-seq analysis was used to identify 1,317 (UP, 239; DOWN, 1078) differentially expressed genes between papillomas and normal mucosa. The involvement of some hub proteins (e.g., FN1, CXCL8, L10, JUN, and FOS) in the pathogenesis of primary middle ear papillomas was found to align with the observed clinical features.

CONCLUSION

The middle ear oncocytic papillomas were extremely rare and remained incompletely understood. The findings of this first RNA-seq analysis of this rare tumor may serve to enhance comprehension of and aid in the management of middle ear papillomas.

Biomarkers for Biodosimetry and Their Role in Predicting Radiation Injury

Radiation-related normal tissue injury sustained during cancer radiotherapy or in a radiological or mass casualty nuclear incident is a major health concern. Reducing the risk and mitigating consequences of radiation injury could have a broad impact on cancer patients and citizens. Efforts to discover biomarkers that can determine radiation dose, predict tissue damage, and aid medical triage are underway. Exposure to ionizing radiation causes changes in gene, protein, and metabolite expression that needs to be understood to provide a holistic picture for treating acute and chronic radiation-induced toxicities. We present evidence that both RNA (mRNA, microRNA, long noncoding RNA) and metabolomic assays may provide useful biomarkers of radiation injury. RNA markers may provide information on early pathway alterations after radiation injury that can predict damage and implicate downstream targets for mitigation. In contrast, metabolomics is impacted by changes in epigenetics, genetics, and proteomics and can be considered a downstream marker that incorporates all these changes to provide an assessment of what is currently happening within an organ. We highlight research from the past 10 years to understand how biomarkers may be used to improve personalized medicine in cancer therapy and medical decision-making in mass casualty scenarios.

A Novel 2-Metagene Signature to Identify High-Risk HNSCC Patients amongst Those Who Are Clinically at Intermediate Risk and Are Treated with PORT

(1) Background: Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) who are biologically at high risk for the development of loco−regional recurrences after postoperative radiotherapy (PORT) but at intermediate risk according to clinical risk factors may benefit from additional concurrent chemotherapy. In this matched-pair study, we aimed to identify a corresponding predictive gene signature. (2) Methods: Gene expression analysis was performed on a multicenter retrospective cohort of 221 patients that were treated with postoperative radiochemotherapy (PORT-C) and 283 patients who were treated with PORT alone. Propensity score analysis was used to identify matched patient pairs from both cohorts. From differential gene expression analysis and Cox regression, a predictive gene signature was identified. (3) Results: 108 matched patient pairs were selected. We identified a 2-metagene signature that stratified patients into risk groups in both cohorts. The comparison of the high-risk patients between the two types of treatment showed higher loco−regional control (LRC) after treatment with PORT-C (p < 0.001), which was confirmed by a significant interaction term in Cox regression (p = 0.027), i.e., the 2-metagene signature was indicative for the type of treatment. (4) Conclusion: We have identified a novel gene signature that may be helpful to identify patients with high-risk HNSCC amongst those at intermediate clinical risk treated with PORT, who may benefit from additional concurrent chemotherapy.