Abstract
Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is rare, usually presents at an advanced stage, and is a more aggressive tumor with poor prognosis. The University of Pittsburgh TNM staging system commonly used in prognostication is not perfect, and more accurate biomarkers predicting prognosis are needed. Tumor budding is an established negative prognostic factor at the invasive front in colorectal cancer. Moreover, immunohistochemical studies showed that laminin 5-γ2 (Ln5-γ2) is expressed at the invasive front in tumor or tumor budding cells. We assessed the prognostic significance of tumor budding and Ln5-γ2 expression by performing Ln5-γ2 immunohistochemistry and evaluated the degree of tumor budding in pre-treatment biopsy specimens, and investigated their correlations to clinicopathological parameters in patients with SCC of the EAC. Patients whose tumors had high budding grade and Ln5-γ2 expression had significantly shorter survival times. Budding grade was significantly correlated with Ln5-γ2 expression. Multivariate analysis revealed that high budding grade predicted poorer prognosis regardless of disease stage. Our results suggested that budding grade and Ln5-γ2 expression can be used as indicators of poor prognosis in patients with SCC of the EAC.
Highlights
Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is an aggressive malignancy with a poor prognosis
We reported that even in the early stages of SCC of the EAC, diffuse expression of laminin 5-γ2 (Ln5-γ2) is associated with a poor prognosis (Nakagawa et al 2013)
Grading for tumor budding/sprouting Based on the Japanese Classification of Colorectal Carcinoma (JCCC) (Rectum JSfCotCa 2013), we defined tumor budding/sprouting as a cancer cell nest consisting of five or Clinical and histopathological findings Table 1 summarizes the clinicopathological characteristics of 46 patients [25 male and 21 female; age range, Fig. 1 Hematoxylin-eosin staining of SCC of the EAC showing tumor budding/sprouting (a–d) and cytokeratin immunohistochemistry (CK-IHC) for tumor budding/sprouting (e–h) at the invasive front
Summary
Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is an aggressive malignancy with a poor prognosis. A revised University of Pittsburgh (Pittsburg, PA, USA) staging system was proposed in the year 2000 (Moody et al 2000) This system is the classification tool that is commonly used for prognosis and treatment decisions in patients with SCC of the EAC (Bacciu et al 2013; Prasad et al 2014; Masterson et al 2014; Nakagawa et al 2006; Moody et al 2000). This tool does not correctly classify every patient (Prasad et al 2014; Mazzoni et al 2014); the number is small, there are some patients with tumors that recur
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