AXIN2 and SNAIL expression predict the risk of recurrence in cutaneous squamous cell carcinoma after Mohs micrographic surgery

Zhao,Guohua; Kim,Ki‑Yeol; Zheng,Zhenlong; Oh,Yeongjoo; Yoo,Dae  San; Lee,Myung  Eun; Chung,Kee  Yang; Roh,Mi  Ryung; Jin,Zhehu

doi:10.3892/ol.2020.11324

AXIN2 and SNAIL expression predict the risk of recurrence in cutaneous squamous cell carcinoma after Mohs micrographic surgery

Authors:
- Guohua Zhao
- Ki‑Yeol Kim
- Zhenlong Zheng
- Yeongjoo Oh
- Dae San Yoo
- Myung Eun Lee
- Kee Yang Chung
- Mi Ryung Roh
- Zhehu Jin
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Affiliations: Department of Dermatology, Yanbian University Hospital, Yanji, Jilin 133000, P.R. China, Department of Dental Education, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea, Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
Published online on: January 21, 2020 https://doi.org/10.3892/ol.2020.11324
Pages: 2133-2140
Copyright: © Zhao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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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.

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