Clinicopathological correlation of stem cell markers expression in oral squamous cell carcinoma; relation to patients` outcome

Expression of stem cell biomarker CD44 in oral squamous cell carcinoma and its association with lymph node metastasis and TNM staging

BACKGROUND

Oral squamous cell carcinoma (OSCC) is one of the most prevalent cancers in the world. OSCC is a highly invasive lesion frequently having soaring morbidity as well as substantial mortality, attributed to resistance to therapy, metastasis, and recurrence driven by specific populations of cancer stem cells (CSC). The evidence of the association of expression of stem cell biomarker CD44 and metastatic potential of the tumor is inconclusive in OSCC and hence needs further evaluation.

OBJECTIVES

To determine the immunohistochemical expression of CD44 in OSCC and to find its association with lymph node metastasis and TNM staging.

MATERIALS AND METHODS

One hundred and five histologically proven cases of OSCC were studied. Histopathological parameters like depth of invasion, presence of lymph node metastasis, grading, and TNM staging were done according to the new AJCC staging criteria. Both intensity and proportion of CD44 expression were recorded.

RESULTS

The mean age observed in this study was 52.59 years with a male: female ratio of 1:3.76. Forty-nine cases (46.6%) showed a depth of invasion of more than 10 mm. Fifty-two out of one hundred and five cases (49%) had nodal involvement. TNM staging was 5.7%, 7.6%, 44.7%, and 42% for stages I, II, III, and IV, respectively. The majority of the cases (87.5%) showed CD44 expression in the tumor. There was a significant association between the CD44 expression and lymph node metastases (P < 0.001). Higher CD44 expression was seen in stages III and IV (P < 0.001).

CONCLUSION

CD44, a stem cell biomarker is significantly associated with higher TNM stage and lymph node metastases. This may be useful in predicting the tumor behavior in the small biopsy.

[Cancer stem cells in oral squamous cell carcinoma. Literature review]

Objective

To perform a literature review on oral squamous cell carcinoma, the presence of cancer stem cells; their association with the course of the disease and therapeutic applications.

Methods

: A search was performed in the PubMed database by entering the following algorithm: ((((neoplastic stem cells [MeSH Terms ]) OR (Cancer stem cells [Text Word ])) AND (Squamous Cell Carcinoma of Head and Neck [MeSH Terms])) AND (Oral squamous cell carcinoma [Text Word ]), to find articles in english published between 2012 and 2022. The PRISMA diagram was used to identify and select the articles.

Results

A result of 49 articles was obtained; of which 27 were chosen according to the title and abstract in their association with the topic. In addition, 8 additional articles suggested by their relationship with the information previously searched were included. In total, 35 articles were evaluated. There has been found that tumoral cells in squamous oral carcinoma are heterogeneous since they include cancer stem cells wich possess characteristics of stem and neoplasic cells; which possess characteristics of stem cells as well as neoplastic cells; they have been associated with disease progression, recurrence, and metastasis and have been considered to be a key mechanism of therapy failure.

Conclusions

The expression of stem cell markers in oral squamous cell carcinomas has been demonstrated and has contributed to their identification in oral squamous cell carcinomas and has been implicated in the behavior of cancer cells. New therapeutic measures aimed at eliminating cancer stem cells have been proposed and developed.

High CD44 Immunoexpression Correlates with Poor Overall Survival: Assessing the Role of Cancer Stem Cell Markers in Oral Squamous Cell Carcinoma Patients from the High-Risk Population of Pakistan

Oral squamous cell carcinoma (OSCC) is a top-ranked cancer in the Pakistani population, and patient survival has remained unchanged at ∼50% for several decades. Recent advances have claimed that a subset of tumour cells, called cancer stem cells (CSCs), are responsible for tumour progression, treatment resistance, and metastasis, which leads to a poor prognosis. This study investigated the impact of CSC markers expression on overall survival (OS) and disease-free survival (DFS) of OSCC patients. Materials and Methods. Immunohistochemistry was used to evaluate CD44, CD133, L1CAM, and SOX2 expression in a well-characterized cohort of 100 Pakistani patients with primary treatment naïve OSCC. The immunoreactivity for each marker was correlated with patient clinicopathologic characteristics, oral cancer risk chewing habits, and survival. The minimum follow-up time for all patients was five years, and survival estimates were calculated using the Kaplan–Meier method and Cox proportional hazards model. Results. In this cohort of 100 patients, there were 57 males and 43 females. The median OS and DFS time durations observed were 64 and 52.5 months, respectively. Positive expression for CD44, CD133, L1CAM, and SOX2 was observed in 33%, 23%, 41%, and 63% of patients. High CD44 expression correlated with decreased OS (P=0.047) but did not influence DFS. However, CD133, L1CAM, and SOX2 had no effect on either OS or DFS. Tonsils, nodal involvement, and AJCC stage were independent predictors of worse OS and DFS both. Conclusion. Of the CSC markers investigated here, only CD44 was a predictor for poor OS. CD44 was also associated with advanced AJCC and T stages. Interestingly, CD133 was significantly lower in patients who habitually consumed oral cancer risk factors.