Prognostic Value of Selected Epithelial‐Mesenchymal Transition and Immune Checkpoint Markers in Predicting Malignant Transformation of Oral Leukoplakia
Jiveswara Vijiakumar, Thomas George Kallarakkal, Lee Peng Karen‐Ng, Samadara Siriwardena, Wanninayake Mudiyanselage TilakaratneABSTRACT
Aim
This study investigates the prognostic potential of epithelial‐mesenchymal transition (EMT) markers (E‐cadherin, N‐cadherin, Twist) and immune checkpoint markers (PD‐1, PD‐L1) in predicting malignant transformation (MT) of oral leukoplakia (OL).
Methodology
Immunohistochemistry (IHC) was performed on 56 OL tissue samples, categorized equally into progressive (transformed to higher‐grade dysplasia or OSCC within 3 years) and non‐progressive groups. Expression levels of E‐cadherin, N‐cadherin, Twist, PD‐1, and PD‐L1 were systematically assessed.
Results
Progressive OL cases showed descriptive trends of lower E‐cadherin expression, higher N‐cadherin and Twist expression compared with non‐progressive cases; however, these EMT‐marker differences were not statistically significant. PD‐1 expression was significantly higher in progressive OL ( p = 0.038) compared with non‐progressive OL. When stratified into non‐progressive, dysplasia‐progressive, and OSCC‐progressive subsets, PD‐L1 expression demonstrated significant variation ( p = 0.018). Higher PD‐1 expression was significantly associated with progressive OL in males ( p = 0.02) and correlated with a shorter time to progression (τb = 0.456, p = 0.004).
Conclusion
The findings suggest that immune checkpoint markers, particularly PD‐1 and PD‐L1, may be associated with progression in OL and may warrant further validation as adjunctive prognostic markers.