Prognostic Implications of ALDH1 and Notch1 in Different Subtypes of Oral Cancer

Silas Antonio Juvencio de Freitas Filho; Cláudia Malheiros Coutinho-Camillo; Katia Klug Oliveira; Bárbara Beltrame Bettim; Clóvis Antônio Lopes Pinto; Luiz Paulo Kowalski; Denise Tostes Oliveira

doi:10.1155/2021/6663720

Prognostic Implications of ALDH1 and Notch1 in Different Subtypes of Oral Cancer

J Oncol. 2021 Feb 13:2021:6663720. doi: 10.1155/2021/6663720. eCollection 2021.

Authors

Silas Antonio Juvencio de Freitas Filho¹, Cláudia Malheiros Coutinho-Camillo², Katia Klug Oliveira², Bárbara Beltrame Bettim², Clóvis Antônio Lopes Pinto³, Luiz Paulo Kowalski⁴, Denise Tostes Oliveira¹

Affiliations

¹ Department of Surgery, Stomatology, Pathology and Radiology (Area of Pathology), Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
² International Research Center, A.C.Camargo Cancer Center, São Paulo, Brazil.
³ Department of Pathology, A.C.Camargo Cancer Center, São Paulo, Brazil.
⁴ Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, São Paulo, Brazil.

Abstract

Background: The present study aimed to investigate the clinical significance and prognostic value of the immunoexpression of cancer stem cell markers, ALDH1 and Notch1, in subtypes of oral squamous cell carcinoma.

Materials and methods: The expression of ALDH1 and Notch1 in 63 patients with well and poorly differentiated oral squamous cell carcinomas and their subtypes, verrucous carcinoma and basaloid squamous cell carcinoma, was evaluated by immunohistochemistry. The semi-quantitative analysis of the ALDH1 and Notch immunoexpression levels, based on the capture of 10 microscopic fields, at 400X magnification, at the invasive tumor front was performed and associated with clinicopathological variables using the chi-square test or Fisher's exact test. The overall and disease-free survival rates were estimated according to the Kaplan-Meier method and the curves were compared using the log-rank test. The independent effects of variables were calculated using Cox's proportional hazards regression model.

Results: Strong ALDH1 and Notch1 expression was observed in 16 (25.4%) and 27 (42.9%) oral squamous cell carcinomas including their subtypes, respectively. Most tumors with strong immunoexpression of ALDH1 were basaloid squamous cell carcinoma (56.3%). Statistically significant associations were observed between the strong immunoexpression of Notch1 in poorly differentiated oral squamous cell carcinoma with perineural infiltration (p = 0.011) and lymph node involvement (pN+) (p = 0.034). The strong immunoexpression of ALDH1 was a prognostic factor associated with worse overall survival (p = 0.040) for patients with oral cancer.

Conclusion: The strong immunoexpression of Notch1 can contribute to identification of patients with poorly differentiated oral squamous cell carcinoma, who have perineural infiltration or lymph node metastasis. In addition, the strong immunoexpression of ALDH1 may help to identify a worse prognosis in patients with oral squamous cell carcinoma and their subtypes.