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Background <p>Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, often associated with poor outcomes due to metastasis and late detection. The epithelial-to-mesenchymal transition (EMT) is central to OSCC progression, but the prognostic role of EMT markers remains unclear. This systematic review and meta-analysis evaluated five key EMT markers-E-cadherin, EpCAM, Vimentin, TWIST, and SNAIL-in OSCC.</p> Methods <p>Following PRISMA guidelines, studies were retrieved from PubMed, Scopus, Embase, ClinicalTrials.gov, and Google Scholar up to May 2025. Pooled odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using RevMan 5.4.1 Heterogeneity was assessed by the I2 index, and fixed- or random-effects models were applied.</p> Results <p>Seventy-three observational studies were included. Vimentin showed the strongest prognostic effect, being significantly associated with lymph node metastasis (OR = 11.84, 95% CI 7.56–18.53, <i>p</i> &lt; 0.00001), advanced TNM stage (OR = 6.88, <i>p</i> &lt; 0.00001), poor differentiation (OR = 7.37, <i>p</i> &lt; 0.00001), and poor overall survival (HR = 5.09, <i>p</i> &lt; 0.00001). TWIST (HR = 4.96, <i>p</i> &lt; 0.00001) and SNAIL (HR = 2.06, <i>p</i> = 0.0003) were also strongly predictive of aggressive clinicopathological features and worse survival. Loss of E-cadherin correlated with poor differentiation (OR = 2.80, <i>p</i> &lt; 0.00001) and reduced disease-free survival (RR = 0.80, <i>p</i> = 0.0005), though its effect on overall survival was inconsistent. EpCAM expression showed context-dependent roles, with high expression linked to advanced stage and poor OS, whereas low expression predicted poor differentiation. Overall, Vimentin and TWIST consistently emerged as the strongest predictors of adverse outcomes, while preserved E-cadherin was protective.</p> Conclusion <p>Vimentin, TWIST, and SNAIL are strong predictors of aggressive disease and poor survival in OSCC, while preserved E-cadherin is protective. EMT markers hold promise for prognostic assessment and precision management in OSCC.</p> Graphical abstract <p></p>

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Association of Epithelial to Mesenchymal transition Markers on Prognosis and Clinicopathological Characteristics in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Dharmendra Kumar,
  • Anurag Gupta,
  • Sushil Agrahari,
  • Saurabh Singh,
  • Seema Gupta,
  • Vijay Kumar,
  • Satyendra Kumar Singh

摘要

Background

Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, often associated with poor outcomes due to metastasis and late detection. The epithelial-to-mesenchymal transition (EMT) is central to OSCC progression, but the prognostic role of EMT markers remains unclear. This systematic review and meta-analysis evaluated five key EMT markers-E-cadherin, EpCAM, Vimentin, TWIST, and SNAIL-in OSCC.

Methods

Following PRISMA guidelines, studies were retrieved from PubMed, Scopus, Embase, ClinicalTrials.gov, and Google Scholar up to May 2025. Pooled odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using RevMan 5.4.1 Heterogeneity was assessed by the I2 index, and fixed- or random-effects models were applied.

Results

Seventy-three observational studies were included. Vimentin showed the strongest prognostic effect, being significantly associated with lymph node metastasis (OR = 11.84, 95% CI 7.56–18.53, p < 0.00001), advanced TNM stage (OR = 6.88, p < 0.00001), poor differentiation (OR = 7.37, p < 0.00001), and poor overall survival (HR = 5.09, p < 0.00001). TWIST (HR = 4.96, p < 0.00001) and SNAIL (HR = 2.06, p = 0.0003) were also strongly predictive of aggressive clinicopathological features and worse survival. Loss of E-cadherin correlated with poor differentiation (OR = 2.80, p < 0.00001) and reduced disease-free survival (RR = 0.80, p = 0.0005), though its effect on overall survival was inconsistent. EpCAM expression showed context-dependent roles, with high expression linked to advanced stage and poor OS, whereas low expression predicted poor differentiation. Overall, Vimentin and TWIST consistently emerged as the strongest predictors of adverse outcomes, while preserved E-cadherin was protective.

Conclusion

Vimentin, TWIST, and SNAIL are strong predictors of aggressive disease and poor survival in OSCC, while preserved E-cadherin is protective. EMT markers hold promise for prognostic assessment and precision management in OSCC.

Graphical abstract