title: Activin A immunoexpression as predictor of occult lymph node metastasis and overall survival in oral tongue squamous cell carcinoma.
abstract: BACKGROUND
  The presence of regional lymph node metastasis has an important impact on clinical management and prognostication of patients with oral tongue squamous cell carcinoma (SCC). Approximately 30% to 50% of patients with oral tongue SCC have regional metastasis at diagnosis, but the limited sensibility of the current diagnostic methods used for neck staging does not allow detection of all cases, leaving a significant number of undiagnosed metastasis (occult lymph node metastasis). In this study, we evaluated whether clinicopathologic features and immunohistochemical detection of carcinoma-associated fibroblasts (CAFs) and activin A could be predictive markers for occult lymph node metastasis in oral tongue SCC.
  
  
  METHODS
  One hundred ten patients with primary oral tongue SCC, who were classified with early stage tumor (stage I and II) and received surgical treatment with elective neck dissection, were enrolled in the study.
  
  
  RESULTS
  Among all examined features, only high immunohistochemical expression of activin A was significantly associated with presence of occult lymph node metastasis (p = .006). Multivariate survival analysis using the Cox proportional hazard model showed that the expression of activin A was an independent marker of reduced overall survival with a 5-year survival of 89.7% for patients with low expression compared to 76.5% for those with high expression (hazard ratio [HR], 2.44; 95% confidence interval [CI], 1.55-3.85; p = .012).
  
  
  CONCLUSIONS
  Our results demonstrated that immunodetection of activin A can be useful for prognostication of oral tongue SCC, revealing patients with occult lymph node metastasis and lower overall survival.
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Natalie
authors.initials: N
authors.lastname: Kelner
authors.forename: Priscila Campioni
authors.initials: PC
authors.lastname: Rodrigues
authors.forename: Andreia
authors.initials: A
authors.lastname: Bufalino
authors.forename: Felipe Paiva
authors.initials: FP
authors.lastname: Fonseca
authors.forename: Alan Roger dos
authors.initials: AR
authors.lastname: Santos-Silva
authors.forename: Marcia Cristina Costa
authors.initials: MC
authors.lastname: Miguel
authors.forename: Clóvis Antonio Lopes
authors.initials: CA
authors.lastname: Pinto
authors.forename: Adriana Franco Paes
authors.initials: AF
authors.lastname: Leme
authors.forename: Edgard
authors.initials: E
authors.lastname: Graner
authors.forename: Tuula
authors.initials: T
authors.lastname: Salo
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Ricardo D
authors.initials: RD
authors.lastname: Coletta
mesh_terms: D028341:Activins / Q000378:metabolism*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000378:metabolism* / Q000401:mortality; D005260:Female; D006258:Head and Neck Neoplasms / Q000378:metabolism* / Q000401:mortality; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D000077195:Squamous Cell Carcinoma of Head and Neck; D014062:Tongue Neoplasms / Q000378:metabolism* / Q000401:mortality
chemical_list: C422405:activin A; D028341:Activins
keywords: activin A; carcinoma-associated fibroblast; clinicopathological features; oral tongue squamous cell carcinoma; prognosis