Prognostic significance of immunohistochemical expression of chemerin and CD34-assessed microvessel density in patients with oral squamous cell carcinoma

Abstract Oral squamous cell carcinoma (OSCC), the most commonly diagnosed oral cancer, has a poor prognosis, especially in the advanced stages. Chemerin, an adipokine that plays a significant role in inflammation and adipogenesis, has emerged as a prognostic biomarker in OSCC. The study evaluates immunohistochemical expression of chemerin and CD34-assessed microvessel density, and investigates their association with clinicopathological parameters and disease-free survival (DFS) in OSCC patients. The study consisted of tissue sections from 184 histopathologically diagnosed cases of OSCC stained by immunohistochemistry for chemerin. Microvessel density (MVD) was assessed using the hotspot method based on CD34 immunostaining. For survival analysis, three separate Cox regression models were constructed for chemerin expression, CD34-assessed microvessel density, and a composite score combining both to assess their effect on DFS. Composite scoring was based on chemerin expression and MVD. Group 1 includes low chemerin + low MVD; Group 2: low chemerin + high MVD; Group 3: High chemerin + low MVD; Group 4: high chemerin + high MVD. Kaplan–Meier survival curves were used for survival analysis, and the Cox regression model for risk assessment. p < 0.05 was considered statistically significant. High chemerin expression was associated with advanced histopathological grade ( p < 0.001) and TNM stage (III-IV) ( p = 0.013), the presence of perineural invasion ( p = 0.022), increased depth of invasion (> 5 mm) ( p = 0.002), and tumor size (pT) (> 4 cm) ( p = 0.016). A statistically significant positive correlation was observed between high chemerin expression and increased microvessel density (MVD), highlighting its role in tumor angiogenesis ( p < 0.001). Advanced TNM stage (III-IV) was an independent predictor of reduced DFS in all three models. Model 1 involving chemerin showed significance only in the univariate analysis ( p = 0.001). Whereas model 2, involving CD34-assessed MVD, showed statistical significance only in the univariate analysis ( p = 0.007). In the multivariate analysis involving model 3, the composite groups (2–4) showed higher hazard ratios for reduced DFS than the reference group 1. Chemerin overexpression is associated with tumor angiogenesis, and its combined evaluation helped in improving the prognostic value compared to individual marker analysis. These findings suggest that chemerin, when combined with other prognostic biomarkers, can help with risk stratification in OSCC, which further require external validation.