Zhao Guohua, Kim Ki-Yeol, Zheng Zhenlong, Oh Yeongjoo, Yoo Dae San, Lee Myung Eun, Chung Kee Yang, Roh Mi Ryung, Jin Zhehu
Department of Dermatology, Yanbian University Hospital, Yanji, Jilin 133000, P.R. China.
Department of Dental Education, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea.
Oncol Lett. 2020 Mar;19(3):2133-2140. doi: 10.3892/ol.2020.11324. Epub 2020 Jan 21.
Recurrence is a common complication observed during cutaneous squamous cell carcinoma (cSCC) treatment; however, biomarkers for predicting recurrence in cSCC remain unknown. The present study aimed to investigate the predictive value of axis inhibition protein 2 (AXIN2) and SNAIL expression in cSCC recurrence. AXIN2 and SNAIL expression was evaluated using immunohistochemistry in 111 cSCC tissue samples obtained from 18 patients who presented recurrence (recurrence interval, 1-91 months) and 93 patients who did not experience recurrence following Mohs micrographic surgery (MMS) during the follow-up period (156 months). Nomogram construction was performed using patients' clinicopathological characteristics and AXIN2 and SNAIL protein expression. The results demonstrated that high AXIN2 (histoscore >100) and SNAIL (histoscore >100) expression was detected in 35 and 44 cSCC tissues, respectively. Furthermore, the expression levels of AXIN2 and SNAIL were significantly associated in patients with cSCC (P=0.001). AXIN2 and SNAIL expression levels were significantly associated with tumor size (P=0.021 and P=0.044, respectively) and recurrence of cSCC (P=0.017 and P=0.042, respectively). In addition, the results of the Kaplan-Meier curve analysis revealed that recurrence-free survival was significantly associated with tumor size (P=0.025), differentiation status (P<0.001), AXIN2 expression (P=0.001) and SNAIL expression (P=0.001). Furthermore, the results of the multivariate analysis demonstrated that age (P=0.043), AXIN2 expression (P=0.001) and SNAIL expression (P=0.045) were independent risk factors for cSCC recurrence in the present cohort. A nomogram for predicting the 1-, 2-, 3-, and 5-year recurrence-free survival was developed for patients with cSCC by including independent risk factors with a concordance index of 0.75. The results suggested that high AXIN2 and SNAIL expression may be considered as potential risk factors for cSCC recurrence. This nomogram may therefore be useful to assess the probability of recurrence in patients with cSCC following MMS.
复发是皮肤鳞状细胞癌（cSCC）治疗过程中常见的并发症；然而，预测cSCC复发的生物标志物仍不明确。本研究旨在探讨轴抑制蛋白2（AXIN2）和SNAIL表达在cSCC复发中的预测价值。采用免疫组织化学方法对111例cSCC组织样本中AXIN2和SNAIL的表达进行评估，这些样本来自18例出现复发的患者（复发间隔为1 - 91个月）以及93例在随访期（156个月）接受莫氏显微外科手术（MMS）后未复发的患者。利用患者的临床病理特征以及AXIN2和SNAIL蛋白表达构建列线图。结果显示，分别在35例和44例cSCC组织中检测到高AXIN2（组织评分>100）和SNAIL（组织评分>100）表达。此外，cSCC患者中AXIN2和SNAIL的表达水平显著相关（P = 0.001）。AXIN2和SNAIL表达水平分别与肿瘤大小（P = 0.021和P = 0.044）以及cSCC复发显著相关（P = 0.017和P = 0.042）。此外，Kaplan - Meier曲线分析结果显示，无复发生存期与肿瘤大小（P = 0.025）、分化状态（P < 0.001）、AXIN2表达（P = 0.001）和SNAIL表达（P = 0.001）显著相关。此外，多因素分析结果表明，年龄（P = 0.043）、AXIN2表达（P = 0.001）和SNAIL表达（P = 0.045）是本队列中cSCC复发的独立危险因素。通过纳入独立危险因素，为cSCC患者绘制了预测1年、2年、3年和5年无复发生存率的列线图，一致性指数为0.75。结果表明，AXIN2和SNAIL高表达可能被视为cSCC复发的潜在危险因素。因此，该列线图可能有助于评估MMS后cSCC患者的复发概率。
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