title: Tenascin-C and fibronectin expression divide early stage tongue cancer into low- and high-risk groups.
abstract: BACKGROUND
  Oral tongue squamous cell carcinoma (OTSCC) metastasises early, especially to regional lymph nodes. There is an ongoing debate on which early stage (T1-T2N0) patients should be treated with elective neck dissection. We need prognosticators for early stage tongue cancer.
  
  
  METHODS
  Mice immunisation with human mesenchymal stromal cells resulted in production of antibodies against tenascin-C (TNC) and fibronectin (FN), which were used to stain 178 (98 early stage), oral tongue squamous cell carcinoma samples. Tenascin-C and FN expression in the stroma (negative, moderate or abundant) and tumour cells (negative or positive) were assessed. Similar staining was obtained using corresponding commercial antibodies.
  
  
  RESULTS
  Expression of TNC and FN in the stroma, but not in the tumour cells, proved to be excellent prognosticators both in all stages and in early stage cases. Among early stages, when stromal TNC was negative, the 5-year survival rate was 88%. Correspondingly, when FN was negative, no cancer deaths were observed. Five-year survival rates for abundant expression of TNC and FN were 43% and 25%, respectively.
  
  
  CONCLUSIONS
  Stromal TNC and, especially, FN expressions differentiate patients into low- and high-risk groups. Surgery alone of early stage primary tumours might be adequate when stromal FN is negative. Aggressive treatments should be considered when both TNC and FN are abundant.
authors.affiliation: Cancer and Translational Medicine Research Unit, University of Oulu, Oulu FI-90014, Finland.|Medical Research Centre, Oulu University Hospital, Oulu FI-90014, Finland.
authors.forename: Elias
authors.initials: E
authors.lastname: Sundquist
authors.affiliation: Cancer and Translational Medicine Research Unit, University of Oulu, Oulu FI-90014, Finland.|Medical Research Centre, Oulu University Hospital, Oulu FI-90014, Finland.|Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm 17176, Sweden.
authors.forename: Joonas H
authors.initials: JH
authors.lastname: Kauppila
authors.affiliation: Department of Physiology, Institute of Biomedicine, University of Oulu, Oulu FI-90014, Finland.|Department of Biochemistry and Molecular Medicine, University of Oulu and Biocenter Oulu, Oulu FI-90014, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Veijola
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki FI-00014, Finland.
authors.forename: Rayan
authors.initials: R
authors.lastname: Mroueh
authors.affiliation: Cancer and Translational Medicine Research Unit, University of Oulu, Oulu FI-90014, Finland.|Medical Research Centre, Oulu University Hospital, Oulu FI-90014, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Lehenkari
authors.affiliation: Department of Research and Development, Finnish Red Cross Blood Service, Helsinki FI-00014, Finland.
authors.forename: Saara
authors.initials: S
authors.lastname: Laitinen
authors.affiliation: Medical Research Centre, Oulu University Hospital, Oulu FI-90014, Finland.|Department of Clinical Chemistry, Institute of Diagnostics, University of Oulu, Oulu FI-90014, Finland.|Northern Laboratory Centre NordLab, Oulu FI-90220, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Risteli
authors.affiliation: Department of Clinical Pathology and Forensic Medicine, University of Eastern Finland, Kuopio FI-70211, Finland.|Cancer Centre of Eastern Finland and Kuopio University Hospital, Kuopio FI-70210, Finland.
authors.forename: Ylermi
authors.initials: Y
authors.lastname: Soini
authors.affiliation: Department of Clinical Pathology and Forensic Medicine, University of Eastern Finland, Kuopio FI-70211, Finland.|Cancer Centre of Eastern Finland and Kuopio University Hospital, Kuopio FI-70210, Finland.|Department of Clinical Pathology, Imaging Centre, Kuopio University Hospital, Kuopio FI-70211, Finland.
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Kosma
authors.affiliation: Oral Pathology and Oral Medicine, Dentistry School, Western Paraná State University, Cascavel 85819-110, Brazil.
authors.forename: Iris
authors.initials: I
authors.lastname: Sawazaki-Calone
authors.affiliation: Department of Oral Diagnosis, Oral Pathology Division, Piracicaba Dental School, University of Campinas, Campinas 13414-903, Brazil.
authors.forename: Carolina Carneiro Soares
authors.initials: CC
authors.lastname: Macedo
authors.affiliation: Medical Informatics and Statistics Research Group, University of Oulu, Oulu FI-90014, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Bloigu
authors.affiliation: Department of Oral Diagnosis, Oral Pathology Division, Piracicaba Dental School, University of Campinas, Campinas 13414-903, Brazil.
authors.forename: Ricardo D
authors.initials: RD
authors.lastname: Coletta
authors.affiliation: Cancer and Translational Medicine Research Unit, University of Oulu, Oulu FI-90014, Finland.|Medical Research Centre, Oulu University Hospital, Oulu FI-90014, Finland.|Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki FI-00014, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Salo
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000473:pathology*; D019468:Disease Management; D005260:Female; D005353:Fibronectins / Q000378:metabolism*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D017154:Stromal Cells / Q000378:metabolism*; D016019:Survival Analysis; D019063:Tenascin / Q000378:metabolism*; D014062:Tongue Neoplasms / Q000378:metabolism / Q000473:pathology*
chemical_list: D005353:Fibronectins; D019063:Tenascin