Quantification of CD44, Epidermal Growth Factor Receptor, E-cadherin, and Vimentin in Oral Squamous Cell Carcinoma as an Indicator for Disease Progression and Survival

Background: Oral squamous cell carcinoma (OSCC) is commonly associated with early recurrence due to loco-regional spread. Changes at the cellular levels can be studied and are often an early indicator of disease progression, much before clinical symptoms become visible. Identifying parameters indicating an impending recurrence could help the clinician plan for early treatment and thus improve survival. Hence, this study aimed to determine if quantifiable parameters could be established for CD44, epidermal growth factor receptor (EGFR), E-cadherin, and vimentin and if these values could be used as indicators of disease progression on follow-up. Method: A total of 150 cases of OSCC were included in the study and followed up linearly for 36 months. Paraffin-embedded tissues of these cases were subjected to immunohistochemical analysis for reactivity to CD44, EGFR, E-cadherin, and vimentin. The immunohistochemical staining correlated with the tumor's clinical and histological grade. Statistical analysis was done using SPSS Statistics version 17 (IBM Corp., Armonk, NY, USA). The receiver operating characteristics (ROC) were deployed for determining the correlation of recurrence with the immunohistochemistry (IHC) markers, while the Kaplan-Meier curve was employed for survival analysis. Results: A recurrence rate of 70.0% and a survival rate of 66.6% were noted after a follow-up period of three years. It was found that both CD44 and E-cadherin decreased with the grade of tumor, while EGFR and vimentin increased with tumor de-differentiation. The E-cadherin was found to be the best predictor of recurrence and survival among all the four markers. Conclusion: The cut-off values could be identified for all four biomarkers, which on follow-up proved to be a valuable tool with a high sensitivity and specificity for predicting recurrence and three-year survival in patients with OSCC.