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AXIN2 and SNAIL expression predict the risk of recurrence in cutaneous squamous cell carcinoma after Mohs
Guohua Zhao1, Ki-Yeol Kim2, Zhenlong Zheng1,3
1Department of Dermatology, Yanbian University Hospital, Yanji, Jilin 133000, P.R. China.
Abstract:
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.
Insights
High expression of axis inhibition protein 2 (AXIN2) and SNAIL predicts recurrence in cutaneous squamous cell carcinoma (cSCC). A new nomogram incorporating these biomarkers aids in assessing cSCC recurrence risk after Mohs micrographic surgery (MMS).
Area of Science:
- Dermatology and Oncology
- Molecular Biology and Biomarkers
Background:
- Cutaneous squamous cell carcinoma (cSCC) recurrence is a significant clinical challenge.
- Reliable biomarkers for predicting cSCC recurrence after treatment are currently lacking.
- Understanding molecular mechanisms underlying cSCC recurrence is crucial for improved patient outcomes.
Purpose of the Study:
- To investigate the predictive value of axis inhibition protein 2 (AXIN2) and SNAIL expression for cSCC recurrence.
- To develop a nomogram for predicting recurrence-free survival in cSCC patients.
- To identify independent risk factors for cSCC recurrence following Mohs micrographic surgery (MMS).
Main Methods:
- Immunohistochemistry was used to evaluate AXIN2 and SNAIL expression in 111 cSCC tissue samples.
- Patient data included those with and without recurrence after MMS, with a follow-up period of 156 months.
- Nomogram construction utilized clinicopathological characteristics and protein expression levels; Kaplan-Meier and multivariate analyses were performed.
Main Results:
- High AXIN2 and SNAIL expression levels were significantly associated with tumor size and cSCC recurrence.
- Recurrence-free survival was significantly linked to tumor size, differentiation status, AXIN2, and SNAIL expression.
- Age, AXIN2, and SNAIL expression were identified as independent risk factors for cSCC recurrence.
Conclusions:
- Elevated AXIN2 and SNAIL expression are potential risk factors for cSCC recurrence.
- A developed nomogram incorporating age, AXIN2, and SNAIL expression demonstrated good predictive accuracy (concordance index of 0.75).
- This nomogram can assist in assessing the probability of recurrence in cSCC patients post-MMS.
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