ORIGINAL ARTICLE

High stromal versican expression predicts unfavourable outcome in oral squamous cell carcinoma

Matti Pukkila¹, Ari Kosunen¹, Kirsi Ropponen², Jukka Virtaniemi¹, Jari Kellokoski¹, Eero Kumpulainen³, Risto Pirinen², Juhani Nuutinen¹, Risto Johansson³ and Veli-Matti Kosma²

¹ Otorhinolaryngology—Head and Neck Surgery, Institute of Clinical Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland
² Pathology and Forensic Medicine, Institute of Clinical Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland
³ Institute of Clinical Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland

Correspondence to:
Correspondence to:
Dr V-M Kosma
Pathology and Forensic Medicine, Institute of Clinical Medicine, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland; velimatti.kosma{at}uku.fi

Background: Versican, an extracellular matrix proteoglycan, has been noted to be expressed in several malignant tumours and has been suggested to play an important role in cancer development and tumour growth.

Aims: To investigate whether the versican expression level in the peritumoural stromal tissue of primary oral squamous cell carcinoma (OSCC) predicts relapse-free or disease-specific survival. Also, to study the associations between versican expression and several other clinicopathological variables, as well as tumour cell proliferation.

Methods: Immunohistochemistry was used to study the expression of versican and tumour cell proliferative activity in 139 OSCCs. All pertinent clinical data were collected retrospectively from the hospital records.

Results: In this cohort, versican expression did not correlate with the clinicopathological factors or tumour cell proliferation. In univariate analyses, higher risk for disease recurrence was associated with higher stromal versican expression score (p = 0.02), positive neck node status (p = 0.02), lower Karnofsky performance status (p = 0.03) and higher tumour cell proliferation index (p = 0.04). Increased disease-specific risk of death was associated with high stromal versican expression score (p = 0.005) higher T class (p = 0.002), positive neck node status (p<0.001), higher stage (p<0.001), poorer histological differentiation (p = 0.005), worse general condition of the patient (p = 0.049) and increased tumour cell proliferative index (p = 0.02). In multivariate disease-specific survival analysis, high stromal versican expression score (p = 0.048), poorer histological differentiation (p = 0.047) and higher stage (p = 0.002) independently predicted poorer disease outcome.

Conclusions: In this cohort, increased stromal versican expression correlated with both increased risk for disease recurrence and shortened survival. High stromal versican expression may thus be considered an independent and adverse prognostic marker in OSCC.

Abbreviations: DFS, disease-free survival; DSS, disease-specific survival; ECM, extracellular matrix; OSCC, oral squamous cell carcinoma; PBS, phosphate-buffered saline

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