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Clinicopathological significance of ZEB-1 and E-cadherin proteins in patients with oral cavity squamous cell carcinoma

Authors Yao X, Sun S, Zhou X, Zhang Q, Guo W, Zhang L

Received 3 May 2016

Accepted for publication 31 October 2016

Published 13 February 2017 Volume 2017:10 Pages 781—790

DOI https://doi.org/10.2147/OTT.S111920

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr William Cho

Xiaofeng Yao,1,2 Shanshan Sun,1,2 Xuan Zhou,1,2 Qiang Zhang,1,2 Wenyu Guo,1,2 Lun Zhang1,2

1Department of Maxillofacial and Otorhinolaryngology Head and Neck Surgery, Tianjin Medical University Cancer Institute and Hospital, 2Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin, People’s Republic of China


Background: Zinc-finger E-box binding homeobox 1 (ZEB-1), a member of the ZFH family, plays a key role in epithelial–mesenchymal transition during tumor progression in various cancers. However, little information is available on ZEB-1 expression in oral cavity squamous cell carcinoma (OSCC).
Methods: The expression levels of ZEB-1 and E-cadherin were assessed by immunohistochemistry in a cohort of 120 patients with OSCC treated by curative operation, and then the correlations between ZEB-1 and E-cadherin expression and clinical factors were evaluated, including patient prognosis. Quantitative real-time polymerase chain reaction (qRT-PCR) assays were performed to assess mRNA levels of ZEB-1 and E-cadherin in 20 matched OSCC specimens.
Results: Patients were followed up for a median period of 66 months (range 8-116 months), and 5-year overall survival was 68.3%. Positive ZEB-1 and E-cadherin immunostaining reactivity was detected in 64 (53.3%) and 53 (44.2%) patients, respectively. There was a negative correlation between ZEB-1 expression and E-cadherin expression. In addition, overexpression of ZEB-1 was significantly associated with recurrence, lymph node metastasis, and pathologic grading of patients, loss of E-cadherin was significantly associated with lymph node metastasis and pathologic grading of patients. Univariate analysis showed that increased ZEB-1 expression, loss of E-cadherin expression, lymph node metastasis, recurrence, and pathology grade were prognostic factors. In multivariate analysis, increased ZEB-1 expression and recurrence remained independent prognostic factors. In particular, patients with both ZEB-1 positivity and loss of E-cadherin expression had a poorer prognosis. qRT-PCR showed that ZEB-1 mRNA expression was higher in OSCC compared to the adjacent nontumorous tissues, while E-cadherin mRNA expression was lower in tumor tissues.
Conclusion: This study shows that overexpression of ZEB-1 and loss of E-cadherin expression are significantly correlated with poor survival in OSCC patients, and ZEB-1 expression might serve as an independent prognostic biomarker of OSCC.

Keywords: ZEB-1, E-cadherin, EMT, oral squamous cell carcinoma, prognosis

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