Investigation of ZEB1 as a Prognostic Marker in Papillary Thyroid Carcinoma: A Retrospective Immunohistochemical Study

Objectives Papillary thyroid carcinoma (PTC) is the most prevalent histological subtype of thyroid cancer. The epithelial-mesenchymal transition (EMT) is a fundamental cellular process that promotes local invasion and progression. Zinc Finger E-Box Binding Homeobox 1 (ZEB1), a transcription factor characterized by its zinc finger clusters, plays a pivotal role in inducing EMT. This study aimed to evaluate the immunohistochemical expression patterns of ZEB1 in PTC and to determine their correlation with various clinicopathological factors. Methods We retrospectively analyzed data from patients who underwent total thyroidectomy for PTC between January 2010 and January 2022. For each case, ZEB1 staining intensity, histological subtype, tumor size, thyroid capsule invasion, extrathyroidal extension (invasion of surrounding tissue), and the number of tumor foci were recorded. Furthermore, lymph node involvement, distant metastasis, and recurrence during the follow-up period were documented. Results ZEB1 expression was weak in 132 (66%) patients and strong (intense) in 68 (34%). A statistically significant association was found between strong ZEB1 expression and histological subtypes, particularly the classic and follicular variants. Furthermore, the strong ZEB1 expression group demonstrated a statistically significant increase in thyroid capsule invasion, extrathyroidal extension, lymph node metastasis, and recurrence rates. Conclusions Assessing ZEB1 expression in PTC patients may provide valuable prognostic insights, potentially guiding surgical strategy and the extent of lymph node dissection. Patients with strong ZEB1 expression may require more rigorous postoperative surveillance due to an elevated risk of recurrence.