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Secondary lymph node metastasis (SLNM) indicates a poor prognosis, and limiting it can improve the survival rate in early-stage tongue squamous cell carcinoma (TSCC). Many factors have been identified as predictors of SLNM; however, there is no unified view. Ras-related C3 botulinum toxin substrate 1 (Rac1) was found to be a promoter of the epithelial-mesenchymal transition (EMT) and is also attracting attention as a new therapeutic target. This study aims to investigate the role of Rac1 in metastasis and its relationship with pathological findings in early-stage TSCC. Rac1 expression levels of 69 cases of stage I/II TSCC specimens and their association with clinicopathological characteristics were evaluated by immunohistochemical staining. The role of Rac1 in oral squamous cell carcinoma (OSCC) was examined after Rac1 in OSCC cell lines was silenced in vitro. High Rac1 expression was significantly associated with the depth of invasion (DOI), tumor budding (TB), vascular invasion, and SLNM (p < 0.05). Univariate analyses revealed that Rac1 expression, DOI, and TB were factors significantly associated with SLNM (p < 0.05). Moreover, our multivariate analysis suggested that Rac1 expression was the only independent determinant of SLNM. An in vitro study revealed that Rac1 downregulation tended to decrease cell migration and proliferation. Rac1 was suggested to be an important factor in the metastasis of OSCC, and it could be useful as a predictor of SLNM. © 2023. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.


Masae Yamazaki, Shoichi Sekikawa, Taiki Suzuki, Satoru Ogane, Kazuhiko Hashimoto, Aya Sasaki, Takeshi Nomura. Rac1 activation in oral squamous cell carcinoma as a predictive factor associated with lymph node metastasis. International journal of clinical oncology. 2023 Sep;28(9):1129-1138

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PMID: 37418142

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