SOX4 expression is closely associated with differentiation and lymph node metastasis in oral squamous cell carcinoma.

SOX4 is a member of the SOX family of transcription regulators. In recent years, SOX4 was shown to be overexpressed in cancers of various organs and related to epithelial-mesenchymal transition, which is a metastatic factor. This study was the first to investigate correlations between SOX4 expression levels and the clinicopathologic factors of oral squamous cell carcinoma (OSCC). We analyzed SOX4 expression levels in 50 patients with OSCC using immunohistochemistry. All samples expressed the SOX4 protein and elevated SOX4 expression was significantly correlated with gender, T status, and stage levels. The expression level of SOX4 in primary foci of poorly differentiated OSCC was higher than that of well differentiated OSCC, which indicated that SOX4 expression is associated with the differentiation of OSCC. However, regardless of the differentiation level in the primary focus, SOX4 expression levels were found to be very high in the metastatic focus. Furthermore, SOX4 expression in metastatic foci was significantly suppressed by neoadjuvant therapy. These results indicate that undifferentiated OSCC cells expressing SOX4 are more likely to metastasize and neoadjuvant therapy including chemoradiation therapy may have some effect in metastatic prevention.