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Schussel JL. Evaluation of biomarkers hypermethylation in oral cancer progression [tese]. São Paulo: Universidade de São Paulo, Faculdade de Odontologia; 2010 Aberrant promoter hypermethylation has been recently proposed as a means for detection of HNSCC in salivary rinses. Here we evaluate the ability of a previously reported 7-gene methylation panel status to correlate with premalignant and malignant oral lesions. We used a large prospective cohort of salivary rinses obtained from patients with benign, dysplastic, and cancer diagnoses to determine promoter hypermethylation in high-risk patients. Clinical risk assessment was performed and correlated with histological diagnosis and biomarker status. Also, a cohort of lip lesions was selected and methylation status of DCC gene was correlated with histology. Quantitative methylation-specific PCR (Q-MSP) was performed analyzing methylation status of 7 genes (CCNA1, MGMT, MINT31, TIMP3, P16, DAPK, DCC) in salivary rinses of 191 patients with oral lesion and 39 lip lesions. Logistic regression and receiver operating characteristic (ROC) analyses were used to examine the association of methylation status with histologic diagnosis and to estimate classification accuracy, respectively. On univariate analysis, diagnosis of dysplasia/cancer was associated with age (OR=1.3, 95% CI= (1.01-1.6, p=0.014) and 7-gene panel methylation (OR=2.2, 95% CI=(1.3–4.0), p=0.006); DCC methylation was also strongly associated (OR=3.3, 95% CI=(1.7-6.6), p=0.004). On multivariable modeling, histologic diagnosis was independently associated with 7 gene panel (OR=2.0, 95% CI=(1.1-3.6), p=0.027) or DCC (OR=2.8, 95% CI=(1.45.7), p=0.004) methylation. A subset analyzed (n=161) without prior biopsy proven malignancy received clinical risk classification based on lesion examination. On univariate analysis, DCC (OR=2.6, 95% CI=(1.1-6.1), p=0.026) and clinical risk classification (OR=2.5, 95% CI=(1.3-5.1), p=0.008) were associated with diagnosis of dysplasia/cancer, and remained significant on multivariate analysis (DCC: OR=2.5, 95% CI= (1.1-6.0), p=0.037, risk classification: OR=2.5, 95% CI=(1.2-5.0), p=0.012). Clinical risk classification identified dysplasia/cancer with a sensitivity of 56% (95% CI=41–71%) and specificity of 66% (95% CI= 57–75%). The sensitivity of clinical risk classification combined with 7-gene panel methylation improved to 71% (95% CI=56– 83%) and with DCC methylation improved to 69% (95% CI=54–81%). The 7-gene panel methylation, as well DCC as a single marker, was independently associated with histologic diagnosis in salivary rinses. No correlation was found between DCC methylation status and histologic diagnosis of lip lesions, probably due different etiology of oral and lip lesions. The results show the potential ability of these biomarkers to predict risk for presence of oral premalignancy and malignancy using a non-invasive approach using salivary rinse and can improve the efficiency of clinical risk classification. Also, reinforces the different etiologic origins of intraoral and lip lesions and the need of different markers for these lesions.

Avaliação da hipermetilação em biomarcadores na progressão do câncer de boca