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Key S, Chia C, Hasan Z, Sundaresan P, Riffat F, Dwivedi RC. Molecular Factors in Carcinoma Ex Pleomorphic Adenoma: Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:1042-1053. [PMID: 37610148 DOI: 10.1002/lary.30993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor. Although multiple reviews have been published on salivary gland malignancies, it has been a decade since the last dedicated systematic review pertaining to CXPA alone was published. This study examines molecular factors in CXPA diagnosis. DATA SOURCES MEDLINE, CINAHL, Embase, Scopus, Web of Science (BIOSIS), Cochrane CENTRAL, Health Collection (Informit), OpenDOAR, and GreyNet International. REVIEW METHODS Systematic review and meta-analysis from inception to October 31, 2022 for all English language studies pertaining to "carcinoma ex pleomorphic adenoma." Predicted incidence of each biomarker was calculated with meta-analysis. Comparison against pleomorphic adenoma (PA) and salivary duct carcinoma (SDC) when reported within the same study are performed. Risk of bias performed with JBI tool for prevalence studies. RESULTS Of 19151 unique studies undergoing abstract screening, 55 studies (n = 1322 patients) underwent data analysis. Biomarkers with >3 studies were p53, HER2, AR, EGFR, PLAG1, ERBB, ER, PR, HMGA2, p16, p63, a-SMA, RAS, PTEN, PDL1, BRAF, PIK3CA, and c-kit. Highest incidence was seen in AR, EGFR, p16, and p53. Significant differences were demonstrated compared with PA and SDC. There was high heterogeneity and overall high risk of bias within studies. CONCLUSION Molecular factors are an area of interest in the diagnosis of CXPA. Our study results support examining CXPA as a discrete cohort in future targeted therapy trials. Laryngoscope, 134:1042-1053, 2024.
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Affiliation(s)
- Seraphina Key
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Clemente Chia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Zubair Hasan
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, New South Wales, Westmead, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, John Hunter Hospital, Sydney, New South Wales, Australia
| | - Purnima Sundaresan
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, Westmead Hospital, New South Wales, Westmead, New South Wales, Australia
- Macquarie University Hospital, Macquarie University, New South Wales, Australia
| | - Raghav C Dwivedi
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Otolaryngology - Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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Chen W, Gu T, Chen Q, Qu C, Zhang C, Hu Y, Xia R, Zhang Y, Wang M, Huang X, Li J, Shi C, Tian Z. Extracellular matrix remodelling and stiffening contributes to tumorigenesis of salivary carcinoma ex pleomorphic adenoma--A study based on patient-derived organoids. Cell Biosci 2023; 13:122. [PMID: 37393249 DOI: 10.1186/s13578-023-01071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/13/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Salivary carcinoma ex pleomorphic adenoma (CXPA) is defined as a carcinoma that develops from benign pleomorphic adenoma (PA). Abnormally activated Androgen signaling pathway and amplification of HER-2/neu(ERBB-2) gene are known to be involved in CXPA tumorigenesis. Recent progress in tumour microenvironment research has led to identification that extracellular matrix (ECM) remodelling and increased stiffness act as critical contributing role in tumour carcinogenesis. This study examined ECM modifications to elucidate the mechanism underlying CXPA tumorigenesis. RESULTS PA and CXPA organoids were successfully established. Histological observation, immunohistochemistry (IHC), and whole-exome sequencing demonstrated that organoids recapitulated phenotypic and molecular characteristics of their parental tumours. RNA-sequencing and bioinformatic analysis of organoids showed that differentially expressed genes are highly enriched in ECM-associated terms, implying that ECM alternations may be involved in carcinogenesis. Microscopical examination for surgical samples revealed that excessive hyalinized tissues were deposited in tumour during CXPA tumorigenesis. Transmission electron microscopy confirmed that these hyalinized tissues were tumour ECM in nature. Subsequently, examination by picrosirius red staining, liquid chromatography with tandem mass spectrometry, and cross-linking analysis indicated that tumour ECM was predominantly composed of type I collagen fibers, with dense collagen alignment and an increased level of collagen cross-linking. IHC revealed the overexpression of COL1A1 protein and collagen-synthesis-related genes, DCN and IGFBP5 (p < 0.05). Higher stiffness of CXPA than PA was demonstrated by atomic force microscopy and elastic imaging analysis. We utilized hydrogels to mimic ECM with varying stiffness degrees in vitro. Compared with softer matrices (5Kpa), CXPA cell line and PA primary cells exhibited more proliferative and invasive phenotypes in stiffer matrices (50Kpa, p < 0.01). Protein-protein interaction (PPI) analysis of RNA-sequencing data revealed that AR and ERBB-2 expression was associated with TWIST1. Moreover, surgical specimens demonstrated a higher TWIST1 expression in CXPA over PA. After knocking down TWIST1 in CXPA cells, cell proliferation, migration, and invasiveness were significantly inhibited (p < 0.01). CONCLUSION Developing CXPA organoids provides a useful model for cancer biology research and drug screening. ECM remodelling, attributed to overproduction of collagen, alternation of collagen alignment, and increased cross-linking, leads to increased ECM stiffness. ECM modification is an important contributor in CXPA tumorigenesis.
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Affiliation(s)
- Wanling Chen
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Ting Gu
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Qianqian Chen
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
- Department of ultrasound, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200011, P.R. China
| | - Chuxiang Qu
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Chunye Zhang
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Yuhua Hu
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Ronghui Xia
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Ying Zhang
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Min Wang
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Xinyi Huang
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
- Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, China
| | - Jiang Li
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China.
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China.
| | - Chaoji Shi
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China.
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China.
- Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, China.
| | - Zhen Tian
- Department of Oral Pathology, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, No. 639, Manufacturing Bureau Road, Huangpu District, Shanghai, 200011, P.R. China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China.
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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Tondi-Resta I, Hobday SB, Gubbiotti MA, Jalaly JB, Rassekh CH, Montone KT, Baloch ZW. Carcinoma Ex Pleomorphic Adenomas: An Institutional Experience and Literature Review. Am J Clin Pathol 2023; 159:502-515. [PMID: 36921078 DOI: 10.1093/ajcp/aqac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/13/2022] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To provide an institutional experience with cases diagnosed as carcinoma ex pleomorphic adenoma (CXPA), including the cytologic and histologic findings and clinical follow-up, followed by a comparison to the experience documented in the literature. METHODS We identified cases of CXPA diagnosed at our institution from 2011 to 2021 and reviewed the cytologic and histologic diagnoses, as well as the treatment and clinical outcomes. Additionally, a literature review of the English literature was performed on CXPAs from 2011 to 2021. RESULTS Forty-one cases of CXPA were identified, with the majority subclassified as adenocarcinoma, not otherwise specified. Five tumors underwent cytogenetic studies and five underwent molecular studies. To date, 36 patients are alive, 8 of whom experienced locoregional recurrence or distant metastasis. CONCLUSIONS Our institutional experience was comparable to that reported in the literature. Further studies are required to inquire about the role of molecular profiles of CXPAs in clinical risk assessment.
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Affiliation(s)
| | - Sara B Hobday
- Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Christopher H Rassekh
- Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Liu S, Lu H, Liu L, Wu Y, Zhu Y, Xu W, Yang W, Zhang C. Carcinoma ex pleomorphic adenoma of the submandibular gland: a retrospective analysis of 86 patients. Oral Dis 2022; 29:1602-1612. [PMID: 35199423 DOI: 10.1111/odi.14168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the prognostic and locoregional metastatic features of carcinoma ex pleomorphic adenoma of submandibular gland (SMG-CXPA) and improve the understanding of this uncommon condition. PATIENTS AND METHODS We retrospectively reviewed patients who were diagnosed with SMG-CXPA. The survival data of SMG-CXPA patients were statistically analyzed using Cox regression and Kaplan-Meier method. The associations between cervical metastasis and clinicopathological parameters were evaluated using chi-squared test. Additionally, two different histological categories (histological grade and invasiveness) and their combination were evaluated with the Kaplan-Meier method and receiver operating characteristic curves. RESULTS In total, 86 patients were diagnosed: 38 clinically node-negative, 31 pathologically node-negative and 17 node-positive patients. Clinical tumor stage and histological grade were two independent prognostic factors for SMG-CXPA. There were significant correlations between sex, tumor size, clinical tumor stage, clinical lymph node stage, histological grade, invasiveness, malignant components, perineural invasion and no specific criteria exist for the clinical outcome. CONCLUSION SMG-CXPA is a high-grade malignancy with an unfavorable prognosis. Elective neck dissection should be performed in SMG-CXPA patients with a risk of locoregional metastasis. Histological grade seems to be a more valuable predictor of lymph node involvement than invasiveness.
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Affiliation(s)
- Shengwen Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Hao Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Limin Liu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yifan Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Yun Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Wanlin Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Wenjun Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Chenping Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
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Meng Y, Yang P, Ma L. Prognostic and clinical implications of c-erbB-2 expression in patients with oral cancer: A meta-analysis. Medicine (Baltimore) 2020; 99:e20575. [PMID: 32502026 PMCID: PMC7306320 DOI: 10.1097/md.0000000000020575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recently, many studies have suggested that the aberrant expression of c-erbB-2 existed in oral cancer (OC) patients and had a correlation with poor clinical features across OC patients. Considering the inconsistent results among published articles, we performed the meta-analysis to assess the prognostic and clinical effect of c-erbB-2 expression on oral tumors. METHODS Web of Science, Embase, and PubMed were retrieved to acquire relevant publications based on selection criteria, up to February 8, 2020. Pooled odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) were applied to evaluate the associations between c-erbB-2 expression and overall survival (OS), disease specific survival, disease-free survival as well as clinicopathology of OC. RESULTS A total of 30 literatures with 1499 patients for survival of OC were enrolled in this meta-analysis. The results indicated that c-erbB-2 overexpression was significantly associated with poor OS (HR = 2.40, 95% CI = 1.53-2.55, P < .05), disease specific survival (HR = 2.60, 95% CI = 1.11-4.10, P < .05) and disease-free survival (HR = 2.22, 95% CI = 1.46-2.99, P < .05). Subgroup analysis based on race showed that the significant prognostic value of c-erbB-2 in OC was found both in Caucasians and Asians (OS of Caucasians, HR = 2.90, 95% CI = 1.50-4.31, P < .05; OS of Asians, HR = 1.90, 95% CI = 1.27-2.53, P < .05). Moreover, OC patients with enhanced c-erbB-2 expression were prone to male (OR = 1.97, 95% CI = 1.22-3.19, P < .05), advanced TNM stage (OR = 1.84, 95% CI = 1.17-2.88, P < .05), lymph node metastasis (OR = 2.23, 95% CI = 1.47-3.36, P < .05) and advanced grade (OR = 1.98, 95% CI = 1.30-3.01, P < .05), but not associated with distant metastasis (OR = 1.65, 95% CI = 0.98-3.04, P > .05). CONCLUSIONS c-erbB-2 may be a potential indicator in the prediction of prognosis and clinicopathological features in OC patients.
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Xia L, Wang Y, Hu Y, Zhang C, Gu T, Wang L, Li J, Yu W, Tian Z. Human epithelial growth factor receptor 2 in human salivary carcinoma ex pleomorphic adenoma: a potential therapeutic target. Cancer Manag Res 2018; 10:6571-6579. [PMID: 30555262 PMCID: PMC6280888 DOI: 10.2147/cmar.s182652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background To inhibit human epithelial growth factor receptor 2 (HER2) in salivary carcinoma ex pleomorphic adenoma (CXPA) and investigate the effects on tumor cell proliferation, cell cycle, and apoptosis. To assess the possibility of blocking HER2 to improve the malignant biological behavior of CXPA. Materials and methods HER2 expression and amplification were examined using an immunofluorescence assay and fluorescence in situ hybridization in 2 CXPA cell lines (SM-AP1 and SM-AP4 cells). The effects on tumor cell proliferation, cell cycle, apoptosis, and HER2 downstream pathways were verified after the application of a HER2 inhibitor. Results HER2 was overexpressed and amplified in SM-AP1 and SM-AP4 cell lines. After blocking HER2, the tumor proliferation and cell cycle were significantly induced, and the apoptosis process was activated. Moreover, the downstream pathways PI3K/AKT and MAPK/ERK were significantly inhibited. Conclusion HER2 was overexpressed and amplified in CXPA cell lines and might thus play an important role in tumor development. Inhibiting HER2 may be a novel targeted therapy for poor biological behavior of CXPA.
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Affiliation(s)
- Liang Xia
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China, .,Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Yang Wang
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Yuhua Hu
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Chunye Zhang
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Ting Gu
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Lizhen Wang
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Jiang Li
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Wenwen Yu
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
| | - Zhen Tian
- Department of Oral Pathology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai 200011, People's Republic of China,
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