A Combined Prediction Model for Lymph Node Metastasis Based on a Molecular Panel and Clinicopathological Factors in Oral Squamous Cell Carcinoma

Shu Wang,Yang Yang,Bo Li,Chong Wang,Huan Liu,Wei Wei,Tiancheng Li,Zhien Feng,Zhengxue Han

doi:10.3389/fonc.2021.660615

Abstract

ObjectiveLymph node metastasis is the most important factor influencing the prognosis of oral squamous cell carcinoma (OSCC) patients. However, there is no proper method for predicting lymph node metastasis. This study aimed to construct and validate a preoperative prediction model for lymph node metastasis and guide personalized neck management based on the gene expression profile and clinicopathological parameters of OSCC.MethodsBased on a previous study of related genes in OSCC, the mRNA expression of candidate genes was evaluated by real-time PCR in OSCC specimens. In this retrospective study, the gene expression profile and clinicopathological parameters of 112 OSCC patients were combined to construct the best prediction model for lymph node metastasis of OSCC. The model was validated with 95 OSCC samples in this study. Logistic regression analysis was used. The area under the curve (AUC) ultimately determined the diagnostic value of the prediction model.ResultsThe two genes CDKN2A + PLAU were closely related to lymph node metastasis of oral squamous cell carcinoma. The model with the combination of CDKN2A, PLAU, T stage and pathological grade was the best in predicting lymph node metastasis (AUC = 0.807, 95% CI: 0.713-0.881, P=0.0001). The prediction model had a specificity of 96% and sensitivity of 72.73% for stage T1 and T2 OSCC (AUC = 0.855, 95% CI: 0.697-0.949, P=0.0001).ConclusionsHigh expression of CDKN2A and PLAU was associated with lymph node metastasis in OSCC. The prediction model including CDKN2A, PLAU, T stage and pathological grade can be used as the best diagnostic model for lymph node metastasis in OSCC.

Highlights

Oral cancer is a common malignant tumor that occurs in oral epithelial tissue and among these tumors, more than 90% are OSCC [1]
Lymph node metastasis occurred in 71 patients with OSCC
Lymph node metastasis occurred in 40 patients with OSCC, including 5 cases of extranodal extension

Summary

Introduction

Oral cancer is a common malignant tumor that occurs in oral epithelial tissue and among these tumors, more than 90% are OSCC [1]. OSCC has a propensity for occult nodal metastasis in the early stage, which is the most important factor influencing patient prognosis [2,3,4,5,6]. Statistics have shown that the 5-year survival rate of OSCC is 50% to 60%; the presence of just one metastatic lymph node designates patients to an advanced stage disease category and has been shown to confer a 50% decrease in long-term survival [7]. Many studies have suggested that elective neck dissection should be performed for all early-stage cN0 OSCC [2, 6]. Clinical practice clearly shows that approximately 70% of early-stage OSCC patients undergo needless neck dissections [8]. To formulate individualized surgical treatment for different OSCC patients, an accurate method to judge lymph node metastasis needs to be urgently explored [9]

Methods

Results

Discussion

Conclusion