Snail as a novel marker for regional metastasis in head and neck squamous cell carcinoma

Mendelsohn, Abie H.; Lai, Chi K.; Shintaku, I. Peter; Fishbein, Michael C.; Brugman, Katherine; Elashoff, David A.; Abemayor, Elliot; Dubinett, Steven M.; St. John, Maie A.

doi:10.1016/j.amjoto.2010.11.018

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 33, Issue 1 , Pages 6-13, January 2012

Snail as a novel marker for regional metastasis in head and neck squamous cell carcinoma

Abie H. Mendelsohn, MD
- Division of Head and Neck Surgery, Department of Surgery, Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Corresponding author. David Geffen School of Medicine at UCLA, Division of Head and Neck Surgery, 62-132 CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. Tel.: +(310) 825 5179; fax: +(310) 206 7393.
Chi K. Lai, MD
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
I. Peter Shintaku, PhD
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Michael C. Fishbein, MD
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Katherine Brugman, BS
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
David A. Elashoff, PhD
- Department of Biostatistics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Elliot Abemayor, MD, PhD
- Division of Head and Neck Surgery, Department of Surgery, Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Steven M. Dubinett, MD
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Maie A. St. John, MD, PhD
- Division of Head and Neck Surgery, Department of Surgery, Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Received 26 June 2010 published online 25 March 2011.

Abstract

Objective

Previous studies have shown Snail expression integral to the epithelial-mesenchymal transition during tumor progression. However, its behavior in clinical head and neck squamous cell carcinomas (HNSCCs) is yet undefined. We therefore sought to (1) investigate clinical and histopathologic characteristics of Snail-positive HNSCC and (2) understand the link between Snail and other commonly used HNSCC tumor markers.

Study Design

A retrospective case-control study was conducted.

Setting

This study was conducted in a large-scale academic center.

Study Subjects

Of 51 consecutive HNSCC, 42 surgical resections were included.

Methods

Two separate pathologists performed standard histopathologic reviews along with immunohistochemistries (Snail, E-cadherin, p16, epidermal growth factor receptor [EGFR]) and in situ hybridization (human papilloma virus [HPV]). Medical review for all cases was performed.

Results

Twenty-two (52%) of 42 cases stained 4+ Snail (>75% staining). The remaining 20 cases were considered negative. Snail was strongly inversely related to E-cadherin expression (ρ = −0.69, P < .001), but statistically independent from HPV, p16, or EGFR expression. Snail(+) tumors were equally represented from each anatomic subsite. Snail(+) tumors were strongly associated with poor differentiation (P < .001) and basaloid classification (P = .004). Snail(+) tumors were also strongly associated with lymphovascular invasion (P = .02), but not perineural invasion. Ultimately, 11 (50%) of 22 of Snail(+) tumors demonstrated positive nodal metastasis and 11 (79%) of 14 node-positive cases were Snail(+) (P = .02).

Conclusion

This pilot study provides promising evidence of Snail' role as a molecular prognostic marker for HNSCC. Snail positivity is significantly predictive of poorly differentiated, lymphovascular invasive, as well as regionally metastatic tumors. Because Snail positivity appears independent of HPV, p16, and EGFR expression, Snail may prove to improve upon these markers' predictive limitations.