Tissue test detects oral cancer risk

By Sarah Guy, medwireNews Reporter

A molecular diagnostic scoring system based on patients' FOXM1 (forkhead box protein M1)-associated gene messenger RNA (mRNA) expression levels is able to quantitatively diagnose and stratify oral carcinoma and its aggressiveness, show UK and Norwegian study results.

The researchers suggest that after further validation, their quantitative Malignancy Index Diagnostic System (qMIDS) could enable the early detection of head and neck squamous cell carcinomas (HNSCC) and guide appropriate treatment.

"A sensitive test capable of quantifying a patient's cancer risk is needed to avoid the adoption of a 'wait-and-see' intervention," said lead investigator Muy-Teck Teh, from Queen Mary University in London, UK, in a press release.

"Detecting cancer early, coupled with appropriate treatment can significantly improve patient outcomes, reduce mortality, and alleviate long-term public healthcare costs," he added.

Co-author Iain Hutchison (Barts and The London NHS Trust, UK) said: "Mouth cancer, if detected early when the disease is most receptive to surgical treatment, has a very high cure rate."

Teh and colleagues developed the qMIDS based on 14 FOXM1 (isoform B)-associated genes implicated in the regulation of the cell cycle, differentiation, aging, genomic stability, epigenetic and stem cell renewal, and two reference genes. qMIDS compares total expression of these 14 target genes with normal gene expression in a healthy control sample of oral tissue.

The team tested qMIDS on tissues from two cohorts (UK and Norway) involving 158 patients with HNSCC, 74 patients with precancer or oral lichen planus, and 67 unaffected individuals.

Median qMIDS scores were significantly different for both cohorts by tissue type, at 1.3, 2.9, and 6.7 in those with health tissue, dysplasia, and cancer, respectively, from the UK, and 1.4, 2.3, and 7.6 in those who were unaffected, had oral lichen planus, and cancer, respectively, from Norway.

Positive cancer detection rates and false-positive rates were good in both data sets, write the researchers, at 94.0% and 3.2% in the Norwegian and 91.0% and 1.3% in the UK cohorts, respectively, using an qMIDS cutoff score of 4.0 or above. The team suggests that a cutoff score of at least 3.5 may still be appropriate since 34% and 25% of those with dysplasia in the UK cohort had qMIDS values of at least 3.5 and at least 4.0, respectively.

"Histopathology, the standard method of HNSCC diagnosis, has key limitations: it is time-consuming (usually several days for tissue fixing and reporting) and the result is subject to pathologists' interpretation," writes the research team in the International Journal of Cancer.

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