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Study of expression patterns of cytokeratin 8 and 18 in oral cancers

Introduction: Squamous cell carcinoma of oral cavity is a morphological heterogenous disease. Cytokeratin (CK) comprises a diverse group of intermediate filament protein that are expressed as pairs in both keratinized and non keratinized epithelial tissue. Very little is known of CK alteration in oral intraepithelial neoplasia III (OIN III) and invasive squamous cell carcinoma (SCC).The aim of the study is to evaluate the expression pattern of CK8/18 in oral carcinoma and to establish any correlation between the expressions of CK8/18 with tumor differentiation. Material and Methods: A total of 104 cases of Paraffin embedded formalin fixed sections from oral squamous cell carcinomas (N=60)  including benign and inflammatory lesions (control;N=40) and oral intraepithethelial lesions(N=4)  were stained  with  Haematoxylin and eosin stain and and then studied immunohistochemically using CK8 and CK18 immunomarkers. Result: Out of  60 cases of invasive squamous carcinomas, cytokeratin 8 showed positivity in 34 cases (56.67%) while expression of cytokeratin 18 was observed in 25 cases(41.67%) but its expression were absent in control and oral intraepithelial cases. Expression of CK 8 was seen in majority of poorly differentiated 4/5(80%) followed by moderately differentiated 12/17(70.59%), with its expression were significantly higher (56.67%) in invasive oral carcinomas compared with controls statistically .Similarly CK18 expression was seen in majority of poorly 4/5 (80%) followed by moderately differentiated squamous cell carcinomas 7/17(41.18%). Conclusion: Aberrant expression of CK8/18 could be correlated with differentiation and recurrence and shows a great promise to be used as prognostic marker for human oral cancer.


Introduction
Oral carcinoma represents a major global health problem. It is the sixth most frequently diagnosed malignancy with high incidence of mortality and morbidity [1]. In India it ranks among the three most common types of cancer and the age standardized incidence rate of oral cancer is 12.6 per 100000 population [2]. The incidence is at a rise because of increase in alcohol and tobacco consumption. There are several types of oral cancers, but around 90% are squamous cell carcinomas [3], most commonly involve the tongue. Often oral cancer is The present study was conducted to assess the incidence of oral cancer in eastern U.P. and to establish the correlation between expression of CK 8 and CK18 with tumor differentiation

Material and Methods
The present study has been conducted on the biopsy specimens received in department of pathology from inpatients and outpatients admitted in dental, surgery

Results
Out of total 104 cases, 40 cases (38.46%) were classified as benign and inflammatory lesions that served as control, 4 cases (3.85%) as oral epithelial dysplasia grade III (OIN III) and 60 cases (57.69%) were of invasive squamous cell carcinomas. The patient characteristics in the present study are as in Table 1.
On immunohistochemical analysis of CK8/18 expression, cytokeratin 8 positivity was observed in 34 out of 60 cases (56.67%) of invasive squamous cell carcinomas with maximum intensity in 17/60 (28.33%) cases and no expression cases of invasive squamous cell carcinomas with maximum intensity seen in 5/60 (8.34%) cases and its expression was also absent in all the benign cases as well as in oral intraepithelial lesions. (Figure 1,2,3).
In well differentiated squamous cell carcinoma, maximum intensity of CK 8 was seen in 8 out of 38 (21.05%) cases whereas in poorly differentiated carcinomas, maximum intensity was seen in 3 out of 5 (60%) cases. ( Table 2 While reaction intensity of CK18 expression was maximum in 40% cases in poorly differentiated carcinomas as compared to 5.26% in well differentiated squamous cell carcinoma. All the results were statistically analysed using chi square test and the p value was found to be highly significant (<0.001).
when control was compared with invasive oral carcinoma while it was not significant (p<0.05) when oral epithelial dysplasia grade 3 was compared with invasive oral carcinoma. (Table 3)   with the study of Oliver et al [6]. Oral cancer was found to be more common among males.
This may be due to their addiction to tobacco chewing and smoking, which is most important risk factor for oral cancer. The male to female ratio in the present group of patients was 4.9:1. Durazzo et al [7] and Bhat et al [8] have also described male preponderance in oral cancer patients in western countries as well as India.
Cases from rural areas predominated over urban population. As such these findings could not be compared with the finding of others due to paucity of such work available in literature. In the present study peak incidence was seen in fourth and fifth decade of life. Similar findings were reported by Wahi et al [9] and Vasudevan et al [ 10] whereas Langdon et al [11] reported higher mean age( 63.6 yrs).