Role of OCT-4 and NANOG in the Malignant Transformation of Oral Submucous Fibrosis: An Immunohistochemical Evaluation
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Oral squamous cell carcinoma (OSCC) is one of the most common cancers of the oral cavity detected worldwide due to delayed clinical diagnosis, expensive therapeutic procedures, and poor prognosis. Oral submucous fibrosis (OSMF) is an oral potentially malignant disorder (OPMD) marked by abnormal collagen production which has a high malignant transformation rate. Subsequent changes occur in the epithelium and connective tissue simultaneously in a coordinated manner and can be aptly mentioned as epithelial-mesenchymal transition (EMT) that facilitates invasiveness and metastasis in carcinomas. The study was conducted to evaluate the immunohistochemical expression of cancer stem cell markers (CSM) OCT-4 and NANOG in OSMF (OSMF) patients, OSCC transformed from OSMF (OSCC+OSMF) patients, and OSCC not transformed from OSMF (OSCC-OSMF) patients. Additionally, the study sought to correlate the immunoexpression levels of OCT-4 and NANOG with the demographic and clinicopathological characteristics of OSMF, OSCC+OSMF, and OSCC-OSMF patients. METHODOLOGY: A total of 86 patients (30 OSMF, 30 OSCC+OSMF, and 26 OSCC-OSMF) were included in the study, wherein 86 haematoxylin and eosin-stained sections, 86 immunohistochemistry slides with OCT-4, and 86 immunohistochemistry slides with NANOG of the same patients were examined to analyse the role of OCT-4 and NANOG immunoexpression in the malignant transformation of OSMF. Result: A high proportion of OSMF (96.6%) and OSCC+OSMF (93.3%) samples showed positive OCT-4 expression, while only 42.3% of OSCC-OSMF cases were positive (p<0.001). NANOG showed a similar trend, being expressed in 93.3% of OSMF, 83.3% of OSCC+OSMF, and 38.5% of OSCC-OSMF samples (p<0.001). Both markers exhibited stronger staining intensity and higher immunoreactive scores in OSMF and OSCC+OSMF than in OSCC-OSMF. Odds ratio (OR) analysis indicated that OSCC+OSMF cases had significantly higher odds of OCT-4 (OR=5.23) and NANOG (OR=12.5) expression compared to OSCC-OSMF. CONCLUSION: The elevated expression of OCT-4 and NANOG in OSMF and OSCC+OSMF suggests their involvement in stem cell-driven pathways underlying malignant transformation. These markers may serve as valuable indicators for identifying OSMF patients at higher risk of developing OSCC and hold potential as prognostic and therapeutic indicators in oral carcinogenesis.
Source: Cureus
DOI: 10.7759/cureus.96351
Author: Diksha Mohapatra
Institution: Siksha O Anusandhan University
Language: English
Subfield: Periodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416025639