背景:结外延伸(ENE)是口腔鳞状细胞癌(OSCC)的不良预后因素,OSCC合并ENE的患者需要进行颈清扫。在这项研究中,我们利用小活检标本中的MMP14表达模式,开发了一种新的基于ENE组织学的病理预测因子.
方法:总共71个手术切除的组织,64淋巴结(LN),从71例OSCC患者中收集了46例活检标本。使用MMP14共评分系统(高风险或低风险)对肿瘤巢和癌症相关成纤维细胞(CAF)中的总MMP14表达进行免疫组织化学分析。针对ENE的存在和不存在进行转移性LN中MMP14表达的关联分析。进行临床病理分析和多变量检查以评估转移和ENE存在的风险。研究了ENE的预测价值以及ENE和MMP14表达对5年总生存率的影响。
结果:在具有ENE的转移性LN标本中检测到高危MMP14表达。肿瘤巢和CAF中的MMP14表达及其在肿瘤-基质界面的过度表达与ENE的存在显着相关。MMP14联合评分系统是ENE的独立风险预测因子,有了敏感性,特异性,活检样本的准确率超过80%;MMP14联合评分系统中高风险的患者在切除和活检中的预后均明显较差.
结论:MMP14联合评分系统通过小活检的免疫组织化学评估准确预测了ENE的存在和不良预后。这个系统很简单,准确,和廉价的免疫组织化学方法,可用于常规病理诊断,以制定有效的治疗计划。
BACKGROUND: Extranodal extension (ENE) is an adverse prognostic factor for oral squamous cell carcinoma (OSCC), and patients with OSCC along with ENE require neck dissection. In this
study, we developed a novel ENE histology-based pathological predictor using MMP14 expression patterns in small biopsy specimens.
METHODS: A total of 71 surgically resected tissue, 64 dissected lymph node (LN), and 46 biopsy specimens were collected from 71 patients with OSCC. Immunohistochemical analyses of total MMP14 expression in the tumour nest and cancer-associated fibroblasts (CAFs) were performed using the MMP14 co-scoring system (high- or low-risk). The association analysis of MMP14 expression in metastatic LNs was performed with respect to the presence and absence of ENE. Clinicopathological analyses and multivariate examinations were performed to assess the risks of metastasis and ENE presence. The predictive value of ENE and the impact of ENE and MMP14 expression on 5-year overall survival were examined.
RESULTS: High-risk MMP14 expression was detected in metastatic LN specimens with ENE. MMP14 expression in tumour nests and CAFs and its overexpression at the tumour-stromal interface significantly correlated with the presence of ENE. The MMP14 co-scoring system was an independent risk predictor for ENE, with sensitivity, specificity, and accuracy of over 80% in biopsy samples; patients with a high risk in the MMP14 co-scoring system had significantly worse prognoses in both resections and biopsies.
CONCLUSIONS: The MMP14 co-scoring system accurately predicted ENE presence and poor prognosis via immunohistochemical evaluation of small biopsies. This system is a simple, accurate, and inexpensive immunohistochemical approach that can be used in routine pathological diagnosis for effective treatment planning.