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Peer-reviewedCC BY-NC-NDJournal of dental sciences

Keratin 18 as a cytoskeletal regulator of epithelial-mesenchymal plasticity and prognostic risk in oral squamous cell carcinoma.

  • Tuan-Yu Kao1,2
  • Hsuan-Chao Lin3
  • Chien-Wei Lai4
  • Julia Yu-Fong Chang4,5
  • Feng-Chiao Tsai6,7,8
  • Jang-Jaer Lee1,2,5
  • Jean-San Chia2
8 affiliations
  1. 1Department of Oral and Maxillofacial Surgery, National Taiwan University Hospital, Taipei, Taiwan.
  2. 2Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University College of Medicine, Taipei, Taiwan.
  3. 3Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
  4. 4Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University College of Medicine, Taipei, Taiwan.
  5. 5Department of Dentistry, National Taiwan University College of Medicine, Taipei, Taiwan.
  6. 6Department of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan.
  7. 7Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
  8. 8National Taiwan University College of Medicine, Taipei, Taiwan.
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Abstract

Background/purpose

Oral squamous cell carcinoma (OSCC) shows poor survival, and conventional staging does not fully capture biologic aggressiveness. Keratin 18 (KRT18) has been linked to malignant progression in epithelial cancers, but its prognostic and biologic significance in OSCC remains unclear. This study investigated whether KRT18 expression is associated with aggressive invasion patterns and adverse outcomes in OSCC, and whether KRT18 contributes to epithelial-mesenchymal plasticity-related malignant phenotypes.Materials and methods

Eighty-eight non-irradiated OSCC specimens obtained after primary surgical resection at National Taiwan University Hospital were analyzed by immunohistochemistry. Associations between KRT18 expression and clinicopathological variables were assessed, and survival was evaluated using Kaplan-Meier and Cox regression analyses. In SAS OSCC cells, KRT18 knockdown, rescue, and overexpression models were established for proliferation, migration, invasion, RNA sequencing, and epithelial-mesenchymal transition (EMT)-marker analyses.Results

KRT18 expression was stronger at the invasive front than at the tumor center and correlated with worst pattern of invasion (WPOI) aggressiveness (Spearman r = 0.4799, P < 0.050). KRT18 positivity was associated with metastasis to >2 lymph nodes and independently predicted poorer overall survival. In multivariate analysis, low and high KRT18 expression showed hazard ratios of 6.93 and 5.67, respectively. KRT18 knockdown suppressed proliferation, collective migration, invasion, and the EMT hallmark gene set (normalized enrichment score = -1.41, adjusted P = 0.037).Conclusion

KRT18 is a histopathologic and prognostic marker of invasive, high-risk OSCC and appears to support epithelial-mesenchymal plasticity-related malignant behavior. However, forced KRT18 overexpression did not consistently enhance malignant phenotypes, indicating that its biologic effects are context-dependent.

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Cite

BibTeXRIS
BibTeX
@article{kao2026keratin,
  title = {{Keratin 18 as a cytoskeletal regulator of epithelial-mesenchymal plasticity and prognostic risk in oral squamous cell carcinoma.}},
  author = {Tuan-Yu Kao and Hsuan-Chao Lin and Chien-Wei Lai and Julia Yu-Fong Chang and Feng-Chiao Tsai and Jang-Jaer Lee and Jean-San Chia},
  journal = {Journal of dental sciences},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jds.2025.07.3701},
  url = {https://europepmc.org/article/MED/42924138},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Keratin 18 as a cytoskeletal regulator of epithelial-mesenchymal plasticity and prognostic risk in oral squamous cell carcinoma.
AU  - Tuan-Yu Kao
AU  - Hsuan-Chao Lin
AU  - Chien-Wei Lai
AU  - Julia Yu-Fong Chang
AU  - Feng-Chiao Tsai
AU  - Jang-Jaer Lee
AU  - Jean-San Chia
PY  - 2026
DA  - 2026/10/01
JO  - Journal of dental sciences
DO  - 10.1016/j.jds.2025.07.3701
UR  - https://europepmc.org/article/MED/42924138
AB  - Background/purpose  Oral squamous cell carcinoma (OSCC) shows poor survival, and conventional staging does not fully capture biologic aggressiveness. Keratin 18 (KRT18) has been linked to malignant progression in epithelial cancers, but its prognostic and biologic significance in OSCC remains unclear. This study investigated whether KRT18 expression is associated with aggressive invasion patterns and adverse outcomes in OSCC, and whether KRT18 contributes to epithelial-mesenchymal plasticity-related malignant phenotypes.Materials and methods  Eighty-eight non-irradiated OSCC specimens obtained after primary surgical resection at National Taiwan University Hospital were analyzed by immunohistochemistry. Associations between KRT18 expression and clinicopathological variables were assessed, and survival was evaluated using Kaplan-Meier and Cox regression analyses. In SAS OSCC cells, KRT18 knockdown, rescue, and overexpression models were established for proliferation, migration, invasion, RNA sequencing, and epithelial-mesenchymal transition (EMT)-marker analyses.Results  KRT18 expression was stronger at the invasive front than at the tumor center and correlated with worst pattern of invasion (WPOI) aggressiveness (Spearman r = 0.4799, P < 0.050). KRT18 positivity was associated with metastasis to >2 lymph nodes and independently predicted poorer overall survival. In multivariate analysis, low and high KRT18 expression showed hazard ratios of 6.93 and 5.67, respectively. KRT18 knockdown suppressed proliferation, collective migration, invasion, and the EMT hallmark gene set (normalized enrichment score = -1.41, adjusted P = 0.037).Conclusion  KRT18 is a histopathologic and prognostic marker of invasive, high-risk OSCC and appears to support epithelial-mesenchymal plasticity-related malignant behavior. However, forced KRT18 overexpression did not consistently enhance malignant phenotypes, indicating that its biologic effects are context-dependent.
SN  - 1991-7902
SN  - 2213-8862
ER  -