Open Access Research article

Twist and snai1 expression in pharyngeal squamous cell carcinoma stroma is related to cancer progression

Anna Jouppila-Mättö123*, Mervi Närkiö-Mäkelä12, Ylermi Soini345, Matti Pukkila12, Reijo Sironen345, Hanna Tuhkanen345, Arto Mannermaa345 and Veli-Matti Kosma345

Author Affiliations

1 Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital, P.O.Box 1777, FI-70211 Kuopio, Finland

2 Institute of Clinical Medicine, Otorhinolaryngology - Head and Neck Surgery, University of Eastern Finland, P.O.Box 1627, FI-70211 Kuopio, Finland

3 Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, P.O.Box 1627, FI-70211 Kuopio, Finland

4 Department of Clinical Pathology, Kuopio University Hospital, P.O.Box 1777, FI-70211 Kuopio, Finland

5 Biocenter Kuopio and Cancer Center of Eastern Finland, University of Eastern Finland, P.O.Box 1627, FI-70211 Kuopio, Finland

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BMC Cancer 2011, 11:350  doi:10.1186/1471-2407-11-350

Published: 11 August 2011

Abstract

Background

Epithelial-mesenchymal transition (EMT) is a crucial process in tumorigenesis since tumor cells attain fibroblast-like features enabling them to invade to surrounding tissue. Two transcription factors, TWIST and SNAI1, are fundamental in regulating EMT.

Methods

Immunohistochemistry was used to study the expression of TWIST and SNAI1 in 109 pharyngeal squamous cell carcinomas.

Results

Tumors with intense stromal staining of TWIST relapsed more frequently (p = 0.04). Tumors with both positive TWIST and SNAI1 immunoreactivity in the stroma were at least Stage II (p = 0.05) and located more often in hypopharynx (p = 0.035). Tumors with negative immunostaining of TWIST and SNAI1 in the stromal compartment were smaller (T1-2) (p = 0.008), less advanced (SI-II) (p = 0.031) and located more often in the oropharynx (p = 0.007). Patients with negative SNAI1 and TWIST immunostaining in tumor stroma had a better 5-year disease-specific and overall survival (p = 0.037 and p = 0.014 respectively).

Conclusion

TWIST and SNAI1 expression in stromal cells is associated with clinical and histopathological characteristics that indicate progressive disease. Negative expression of these EMT-promoting transcription factors predicts a better outcome.

Keywords:
Pharyngeal squamous cell carcinoma; Stromal cells; TWIST; SNAI1; Prognosis; Epithelial-mesenchymal transition