Role of epithelial-mesenchymal markers in predicting metastasis of papillary thyroid carcinoma: A retrospective case-control study

Papillary thyroid carcinoma (PTC) accounts for 90% of thyroid malignancies, with lymph node metastasis being a critical prognostic factor. However, the mechanisms driving metastasis remain unclear. This study investigated the role of E-cadherin and zinc finger E-box-binding homeobox 1 in cancer progression among Iraqi PTC patients.

The expression levels of E-cadherin and zinc finger E-box-binding homeobox 1 were analyzed in 50 Iraqi patients diagnosed with PTC without lymph node metastases, evaluated between January 2015 and December 2021. The Pearson correlation coefficient between these markers and the risk of lymph node metastasis, as well as their relationship to tumor grade and stage, was calculated. The area under the receiver operating characteristic (ROC) curve for both markers was performed. The Medical Ethics Committee of the Iraqi Ministry of Higher Education and Scientific Research (Reference No. 14) approved the study.

This study examined 50 PTC cases, revealing significant associations between E-cadherin and zinc finger E-box-binding homeobox 1 expression and lymph node metastasis, clinical stage, and tumor grade. Zinc finger E-box-binding homeobox 1 expression was higher in metastatic cases (92% vs. 16%), while E-cadherin was lower (24% vs. 84%). Zinc finger E-box-binding homeobox 1 positively correlated with lymph node metastasis (r = 0.68), stage (r = 0.72), and grade (r = 0.56), whereas E-cadherin showed negative correlations (r = -0.60, -0.59, and -0.52, respectively). ROC analysis showed areas under the curve of 0.88 zinc finger E-box-binding homeobox 1 and 0.82 (E-cadherin), suggesting their potential as biomarkers for metastasis prediction.

The study concluded that E-cadherin and zinc finger E-box-binding homeobox 1 are key predictors of lymph node metastasis, tumor grade, and stage in PTC. Monitoring these markers could enhance clinical decision-making and patient management.