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Flores-Hidalgo A, Phero J, Steward-Tharp S, Williamson M, Paquette D, Krishnan D, Padilla R. Immunophenotypic and Gene Expression Analyses of the Inflammatory Microenvironment in High-Grade Oral Epithelial Dysplasia and Oral Lichen Planus. Head Neck Pathol 2024; 18:17. [PMID: 38456941 PMCID: PMC10923754 DOI: 10.1007/s12105-024-01624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Oral lichen planus (OLP) and oral epithelial dysplasia (OED) present diagnostic challenges due to clinical and histologic overlap. This study explores the immune microenvironment in OED, hypothesizing that immune signatures could aid in diagnostic differentiation and predict malignant transformation. METHODS Tissue samples from OED and OLP cases were analyzed using immunofluorescence/immunohistochemistry (IF/IHC) for CD4, CD8, CD163/STAT1, and PD-1/PDL-1 expression. RNA-sequencing was performed on the samples, and data was subjected to CIBERSORTx analysis for immune cell composition. Gene Ontology analysis on the immune differentially expressed genes was also conducted. RESULTS In OED, CD8 + T-cells infiltrated dysplastic epithelium, correlating with dysplasia severity. CD4 + lymphocytes increased in the basal layer. STAT1/CD163 + macrophages correlated with CD4 + intraepithelial distribution. PD-1/PDL-1 expression varied. IF/IHC analysis revealed differential immune cell composition between OED and OLP. RNA-sequencing identified upregulated genes associated with cytotoxic response and immunosurveillance in OED. Downregulated genes were linked to signaling, immune cell recruitment, and tumor suppression. CONCLUSIONS The immune microenvironment distinguishes OED and OLP, suggesting diagnostic potential. Upregulated genes indicate cytotoxic immune response in OED. Downregulation of TRADD, CX3CL1, and ILI24 implies dysregulation in TNFR1 signaling, immune recruitment, and tumor suppression. This study contributes to the foundation for understanding immune interactions in OED and OLP, offering insights into future objective diagnostic avenues.
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Affiliation(s)
- Andres Flores-Hidalgo
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - James Phero
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott Steward-Tharp
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
| | - Megumi Williamson
- Department of Surgical Sciences, East Carolina University School of Dental Medicine, Greenville, USA
| | - David Paquette
- Department of Surgical Sciences, East Carolina University School of Dental Medicine, Greenville, USA
| | - Deepak Krishnan
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ricardo Padilla
- Department of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, USA
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2
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Seebauer C, Freund E, Dieke T, Hasse S, Segebarth M, Rautenberg C, Metelmann HR, Bekeschus S. Decreased inflammatory profile in oral leukoplakia tissue exposed to cold physical plasma ex vivo. J Oral Pathol Med 2023; 52:1021-1028. [PMID: 37827138 DOI: 10.1111/jop.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Oral leukoplakia (OL) is an unfavorable oral disease often resistant to therapy. To this end, cold physical plasma technology was explored as a novel therapeutic agent in an experimental setup. METHODS Biopsies with a diameter of 3 mm were obtained from non-diseased and OL tissues. Subsequently, cold atmospheric pressure plasma (CAP) exposure was performed ex vivo in the laboratory. After 20 h of incubation, biopsies were cryo-conserved, and tissue sections were quantified for lymphocyte infiltrates, discriminating between naïve and memory cytotoxic and T-helper cells. In addition, the secretion pattern related to inflammation was investigated in the tissue culture supernatants by quantifying 10 chemokines and cytokines. RESULTS In CAP-treated OL tissue, significantly decreased overall lymphocyte numbers were observed. In addition, reduced levels were observed when discriminating for the T-cell subpopulations but did not reach statistical significance. Moreover, CAP treatment significantly reduced levels of C-X-C motif chemokine 10 (CXCL10) and granulocyte-macrophage colony-stimulating factor in the OL biopsies' supernatants. In idiopathically inflamed tissues, ex vivo CAP exposure reduced T-cells and CXCL10 as well but also led to markedly increased interleukin-1β secretion. CONCLUSION Our findings suggest CAP to have immuno-modulatory properties, which could be of therapeutic significance in the therapy of OL. Future studies should investigate the efficacy of CAP therapy in vivo in a larger cohort.
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Affiliation(s)
- Christian Seebauer
- Department of Oral, Maxillofacial, and Plastic Surgery, Greifswald University Medical Center, Greifswald, Germany
| | - Eric Freund
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
- Department of General, Visceral, Thoracic, and Vascular Surgery, Greifswald University Medical Center, Greifswald, Germany
| | - Tobias Dieke
- Department of Oral, Maxillofacial, and Plastic Surgery, Greifswald University Medical Center, Greifswald, Germany
| | - Sybille Hasse
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Maria Segebarth
- Department of Oral, Maxillofacial, and Plastic Surgery, Greifswald University Medical Center, Greifswald, Germany
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Christoph Rautenberg
- Department of Oral, Maxillofacial, and Plastic Surgery, Greifswald University Medical Center, Greifswald, Germany
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Hans-Robert Metelmann
- Department of Oral, Maxillofacial, and Plastic Surgery, Greifswald University Medical Center, Greifswald, Germany
| | - Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
- Clinic and Policlinic for Dermatology and Venerology, Rostock University Medical Center, Rostock, Germany
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3
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Cai X, Zhang J, Peng Y, Yao Z, Huang J, Tang Q, Bai J, Yan J, Li L, Zhang H, Li T. The preliminary exploration of immune microenvironment in oral leukoplakia concomitant with oral submucosal fibrosis: A comparative immunohistochemical study. J Oral Pathol Med 2023. [PMID: 37084341 DOI: 10.1111/jop.13434] [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: 12/09/2022] [Revised: 02/16/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Oral leukoplakia concomitant with oral submucous fibrosis is a high-risk oral potentially malignant disorder, but little is known about its immune microenvironment. METHODS Thirty samples of oral leukoplakia concomitant with oral submucous fibrosis, 30 oral leukoplakia samples, and 30 oral submucous fibrosis samples were collected from two hospitals. Immunohistochemistry was performed to analyze expression of T cell biomarkers [CD3, CD4, CD8, and Forkhead box P3 (Foxp3)], a B cell biomarker (CD20), macrophage biomarkers (CD68 and CD163), an immune inhibitory receptor ligand (PD-L1), and Ki-67. RESULTS The numbers of CD3+ (p < 0.001), CD4+ (p = 0.018), and CD8+ (p = 0.031) cells in oral leukoplakia concomitant with oral submucous fibrosis were less than those in oral leukoplakia. The number of CD4+ cells (p = 0.035) in oral leukoplakia concomitant with oral leukoplakia was higher than that in oral submucous fibrosis. More CD3+ (p < 0.001), CD4+ (p < 0.001), Foxp3+ (p = 0.019), and CD163+ (p = 0.029) cells were found in oral leukoplakia than in oral submucous fibrosis. CONCLUSION Various levels of immune infiltration were observed among oral leukoplakia concomitant with oral submucous fibrosis, oral leukoplakia, and oral submucous fibrosis. Characterization of the immune microenvironment may contribute to personalized immunotherapy.
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Affiliation(s)
- Xinjia Cai
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, People's Republic of China
| | - Jianyun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, People's Republic of China
| | - Yinghong Peng
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, People's Republic of China
| | - Zhigang Yao
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, People's Republic of China
| | - Junhui Huang
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, People's Republic of China
| | - Qian Tang
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, People's Republic of China
| | - Jiaying Bai
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Jing Yan
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Long Li
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, People's Republic of China
| | - Heyu Zhang
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Tiejun Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, People's Republic of China
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Shivhare P, Haidry N, Kumar A, Parihar A, Singh A, Subramanyam S. Diode Laser in the Management of Leukoplakia - A Retrospective Study. Ann Maxillofac Surg 2022; 12:178-184. [PMID: 36874766 PMCID: PMC9976845 DOI: 10.4103/ams.ams_117_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Leukoplakia is among the most common potentially malignant disorders encountered in clinical dental practice. The treatment of leukoplakia includes nonsurgical and surgical management. The surgical treatment includes excision, electrocauterisation, laser surgery or cryosurgery. This retrospective study aimed to analyse the efficacy of diode lasers in the management of leukoplakia. Methods The sample consists of 56 cases with 77 leukoplakia sites treated with diode laser between January 2018 and December 2020 with a minimum of six months follow-up. For each patient, personal data was collected along with site of lesions, leukoplakia phase, type of treatment performed (laser ablation or laser excision), side effects, recurrences and malignant transformation. Inferential statistical analysis was then conducted. Results After applying exclusion criteria, 56 cases with 77 leukoplakia sites were included in this study. Males aged >45 years were predominantly affected. Homogeneous leukoplakia (48.1%) was the most common phase. Recurrences were noted in 19.48% of the cases. Compared to laser excision, laser ablation had more recurrences. Gingival lesions showed a higher recurrence rate than other sites in the oral cavity. None of the cases showed malignant transformation. Discussion Laser offers many advantages over other conventional methods including lesser postoperative pain and swelling, bloodless dry operating field and increased patient comfort and requires minimal local anaesthesia. The study concluded that diode laser is an effective surgical treatment modality for treating leukoplakia. Furthermore, the laser excision technique was found to be superior to laser ablation due to lesser recurrence.
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Affiliation(s)
- Peeyush Shivhare
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Naqoosh Haidry
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajay Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajay Parihar
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ankur Singh
- Department of Oral Medicine and Radiology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Shalini Subramanyam
- Department of Oral Medicine and Radiology, Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujarat, India
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Bouaoud J, Bossi P, Elkabets M, Schmitz S, van Kempen LC, Martinez P, Jagadeeshan S, Breuskin I, Puppels GJ, Hoffmann C, Hunter KD, Simon C, Machiels JP, Grégoire V, Bertolus C, Brakenhoff RH, Koljenović S, Saintigny P. Unmet Needs and Perspectives in Oral Cancer Prevention. Cancers (Basel) 2022; 14:cancers14071815. [PMID: 35406587 PMCID: PMC8997728 DOI: 10.3390/cancers14071815] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022] Open
Abstract
Oral potentially malignant disorders (OPMD) may precede oral squamous cell carcinoma (OSCC). Reported rates of malignant transformation of OPMD range from 3 to 50%. While some clinical, histological, and molecular factors have been associated with a high-risk OPMD, they are, to date, insufficiently accurate for treatment decision-making. Moreover, this range highlights differences in the clinical definition of OPMD, variation in follow-up periods, and molecular and biological heterogeneity of OPMD. Finally, while treatment of OPMD may improve outcome, standard therapy has been shown to be ineffective to prevent OSCC development in patients with OPMD. In this perspective paper, several experts discuss the main challenges in oral cancer prevention, in particular the need to (i) to define an OPMD classification system by integrating new pathological and molecular characteristics, aiming (ii) to better identify OPMD at high risk of malignant transformation, and (iii) to develop treatment strategies to eradicate OPMD or prevent malignant transformation.
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Affiliation(s)
- Jebrane Bouaoud
- Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, CNRS 5286, INSERM 1052, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France;
- Department of Translational Research and Innovation, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France; (V.G.); (C.B.)
- Department of Maxillo-Facial Surgery, Assistance Publique des Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
- Correspondence: (J.B.); (P.S.)
| | - Paolo Bossi
- Medical Oncology, ASST Spedali Civili Brescia, I-25064 Brescia, Italy;
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, I-25123 Brescia, Italy
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; (M.E.); (S.J.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Sandra Schmitz
- Department of Medical Oncology and Head and Neck Surgery, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), UCLouvain, 1200 Brussels, Belgium; (S.S.); (J.-P.M.)
| | - Léon C. van Kempen
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Pierre Martinez
- Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, CNRS 5286, INSERM 1052, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France;
- Department of Translational Research and Innovation, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France; (V.G.); (C.B.)
| | - Sankar Jagadeeshan
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; (M.E.); (S.J.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Ingrid Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, F-94805 Villejuif, France;
| | - Gerwin J. Puppels
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Room Ee-1691, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
| | - Caroline Hoffmann
- INSERM U932 Research Unit, Department of Surgery, Institut Curie, PSL Research University, F-75006 Paris, France;
| | - Keith D. Hunter
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK;
| | - Christian Simon
- Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Jean-Pascal Machiels
- Department of Medical Oncology and Head and Neck Surgery, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), UCLouvain, 1200 Brussels, Belgium; (S.S.); (J.-P.M.)
| | - Vincent Grégoire
- Department of Translational Research and Innovation, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France; (V.G.); (C.B.)
- Radiation Oncology Department, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France
| | - Chloé Bertolus
- Department of Translational Research and Innovation, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France; (V.G.); (C.B.)
- Department of Maxillo-Facial Surgery, Assistance Publique des Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Ruud H. Brakenhoff
- Cancer Center Amsterdam, Section Head and Neck Cancer Biology & Immunology, Otolaryngology and Head and Neck Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Pierre Saintigny
- Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, CNRS 5286, INSERM 1052, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France;
- Department of Translational Research and Innovation, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, F-69008 Lyon, France; (V.G.); (C.B.)
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon 1, University Lyon, 28 Promenade Léa et Napoléon Bullukian, F-69008 Lyon, France
- Correspondence: (J.B.); (P.S.)
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Bouaoud J, Foy JP, Tortereau A, Michon L, Lavergne V, Gadot N, Boyault S, Valantin J, De Souza G, Zrounba P, Bertolus C, Bendriss-Vermare N, Saintigny P. Early changes in the immune microenvironment of oral potentially malignant disorders reveal an unexpected association of M2 macrophages with oral cancer free survival. Oncoimmunology 2021; 10:1944554. [PMID: 34239777 PMCID: PMC8238000 DOI: 10.1080/2162402x.2021.1944554] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Understanding the dynamics of the immune microenvironment is critical to the development of immuno-based strategies for the prevention of oral potentially malignant disorders transformation to oral squamous cell carcinoma (OSCC). We used laser capture microdissection and RNA-sequencing to profile the expression of 13 matched pairs of epithelial versus stromal compartments from normal mucosa, hyperplasia, dysplasia, and invasive tumors in the 4-nitroquinolein (4-NQO) murine model of oral carcinogenesis. Genes differentially expressed at each step of transformation were defined. Immune cell deconvolution and enrichment scores of various biological processes including immune-related ones were computed. Immunohistochemistry was also performed to characterize the immune infiltrates by T-cells (T-cells CD3+, helper CD4+, cytotoxic CD8+, regulatory FoxP3+), B-cells (B220+), and macrophages (M1 iNOS+, M2 CD163+) at each histological step. Enrichment of three independent M2 macrophages signatures were computed in 86 oral leukoplakia with available clinical outcome. Most gene expression changes were observed in the stromal compartment and related to immune biological processes. Immune cell deconvolution identified infiltration by the macrophage population as the most important quantitatively especially at the stage of dysplasia. In 86 patients with oral leukoplakia, three M2 macrophages signatures were independently associated with improved oral cancer-free survival. This study provides a better understanding of the dynamics of the immune microenvironment during oral carcinogenesis and highlights an unexpected association of M2 macrophages gene expression signatures with oral cancer free survival in patients with oral leukoplakia.
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Affiliation(s)
- Jebrane Bouaoud
- Tumor Escape, Resistance and Immunity Department, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, Lyon, France.,Department of Translational Medicine, Centre Léon Bérard, Lyon, France.,Department of Maxillo-Facial Surgery, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique Des Hôpitaux De Paris, Paris, France
| | - Jean-Philippe Foy
- Tumor Escape, Resistance and Immunity Department, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, Lyon, France.,Department of Translational Medicine, Centre Léon Bérard, Lyon, France.,Department of Maxillo-Facial Surgery, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique Des Hôpitaux De Paris, Paris, France
| | | | - Lucas Michon
- Department of Translational Medicine, Centre Léon Bérard, Lyon, France
| | - Vincent Lavergne
- Department of Translational Medicine, Centre Léon Bérard, Lyon, France
| | - Nicolas Gadot
- Tumor Escape, Resistance and Immunity Department, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, Lyon, France.,Department of Translational Medicine, Centre Léon Bérard, Lyon, France
| | - Sandrine Boyault
- Department of Translational Medicine, Centre Léon Bérard, Lyon, France
| | - Julie Valantin
- Tumor Escape, Resistance and Immunity Department, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, Lyon, France.,Department of Translational Medicine, Centre Léon Bérard, Lyon, France
| | | | - Philippe Zrounba
- Department of Translational Medicine, Centre Léon Bérard, Lyon, France.,Department of Surgery, Centre Léon Bérard, Lyon, France
| | - Chloé Bertolus
- Department of Translational Medicine, Centre Léon Bérard, Lyon, France.,Department of Maxillo-Facial Surgery, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique Des Hôpitaux De Paris, Paris, France
| | - Nathalie Bendriss-Vermare
- Tumor Escape, Resistance and Immunity Department, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, Lyon, France
| | - Pierre Saintigny
- Tumor Escape, Resistance and Immunity Department, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, Lyon, France.,Department of Translational Medicine, Centre Léon Bérard, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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7
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Pierik AS, Leemans CR, Brakenhoff RH. Resection Margins in Head and Neck Cancer Surgery: An Update of Residual Disease and Field Cancerization. Cancers (Basel) 2021; 13:2635. [PMID: 34071997 PMCID: PMC8198309 DOI: 10.3390/cancers13112635] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
Surgery is one of the mainstays of head and neck cancer treatment, and aims at radical resection of the tumor with 1 cm tumor-free margins to obtain locoregional control. Surgical margins are evaluated by histopathological examination of the resection specimen. It has been long an enigma that approximately 10-30% of surgically treated head and neck cancer patients develop locoregional recurrences even though the resection margins were microscopically tumor-free. However, the origins of these recurrences have been elucidated by a variety of molecular studies. Recurrences arise either from minimal residual disease, cancer cells in the surgical margins that escape detection by the pathologist when examining the specimen, or from precancerous mucosal changes that may remain unnoticed. Head and neck tumors develop in mucosal precursor changes that are sometimes visible but mostly not, fueling research into imaging modalities such as autofluorescence, to improve visualization. Mostly unnoticed, these precancerous changes may stay behind when the tumor is resected, and subsequent malignant progression will cause a local relapse. This led to a clinical trial of autofluorescence-guided surgery, of which the results were reported in 2020. This review focuses on the most recent literature of the improved diagnosis of the resection margins of surgically treated head and neck cancer patients, the pathobiological origin of recurrent disease, and relevant biomarkers to predict local relapse. Directions for further research will be discussed, including potential options for improved and personalized treatment, based on the most recently published data.
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Affiliation(s)
| | | | - Ruud H. Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam Tumor Biology and Immunology Section, Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands; (A.S.P.); (C.R.L.)
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