Abstract. This study examined immunohistochemical expression of ΔNp63, a keratinocyte stem cell marker, in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) and then to elucidate usefulness of ΔNp63 as a marker for diagnosis and prognosis. One-hundred and twelve cases of OL and 81 cases of OSCC were analyzed by immunohistochemical staining for ΔNp63, Ki-67, and cytokeratin 14. These labeling indices (LIs) were calculated, and the association of these LIs with clinicopathologic characteristics in the OL and OSCC was evaluated. In the OL, these LIs increased significantly according to the severity of epithelial dysplasia (p<0.0001). ΔNp63-LI in the OL with malignant transformation was significantly higher than that in the OL without (49.3 vs. 34.2%; p<0.01). In the OSCC, the LIs increased significantly in association with the histologic grade (p<0.0001). A significant difference between the high and low ΔNp63-LI groups was found in the incidence of cervical lymph node and distant metastasis (p<0.05). The prognosis of the high ΔNp63-LI (mean value >73.8%) group is poorer than that of the low ΔNp63-LI (mean value ≤73.8%) group (p<0.05). These results suggested that increased ΔNp63 expression is involved in malignant transformation in epithelial dysplasia and poor prognosis in OSCC.
Introductionp63 gene is a homolog of p53, it is located on chromosome 3q27-29 and encodes multiple isotypes with divergent abilities in a variety of organs (1-4). p63 has two different promoter domains that generate two protein isoforms, TAp63 and ΔNp63; each isoform yields three isotypes (α, β, γ) generated by alternative splicing of the p63 COOH terminus; and TAp63 includes an NH 2 -terminal transactivation domain, which is absent in ΔNp63 (1-4,6,7). TAp63 transactivates p53 target genes to induce apoptosis by inhibiting cell proliferation in response to exposure of cells to DNA-damaging agents such as ultraviolet irradiation. In contrast, ΔNp63 exerts dominant-negative activities against TAp63 and p53, and ΔNp63 is thus considered as an oncoprotein (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).Recent studies have shown that p63 is essential for craniofacial development during morphogenesis, because p63 -/-mice represented craniofacial abnormalities including hypoplasia of jaws and defects of the teeth, hair follicles, lachrymal glands, and salivary glands (1,15). Furthermore, p63 -/-mice showed lack of squamous stratification in the epidermis and oral epithelium, suggesting that p63 plays critical roles in the epithelial development. Pellegrini et al also demonstrated that p63 was expressed in keratinocyte stem cells and involved in the proliferation and maintenance of this cell population (16). Thus, p63 has been characterized as a marker of keratinocyte stem cells.In the tumorigenesis as well as morphogenesis, the existence of a stem-like cell population with a self-renewal potential, capacity of development into multiple lineages, extensive proliferation activity, and high migration capability in the tumor tissue was revealed. ...