Purpose: DKK1 is an antagonist of the Wnt signaling pathway that has various roles in human physiology. Notably, aberrant DKK1  expression is observed in several cancers. In this retrospective study, we assessed the association between DKK1  expression levels and head and neck squamous cell carcinoma (HNSCC) and its prognostic value.
Materials and methods: Using RNA-seq data from HNSCC tumors (N=520) and adjacent normal tissue (N=44) in The Cancer Genome Atlas, we evaluated DKK1  expression levels. Additionally, we evaluated the association of DKK1  expression levels and pathophysiological features of patients with HNSCC and the value of DKK1  expression for prediction of overall survival (OS). We also explored the correlation between DKK1  expression and methylation of its promoter in HNSCC.
Results: DKK1  expression was significantly upregulated in HNSCC compared with normal tissues. Moreover, DKK1  expression was significantly associated with smoking, alcohol abuse, sex, human papillomavirus status, tumor site, tumor invasion, and pathologic stage in HNSCC patients. Kaplan–Meier curves showed that high DKK1  expression was correlated with inferior OS. In addition, univariate and multivariate analyses showed that elevated DKK1  expression was an independent prognostic factor for poor OS (HR: 1.85, 95% CI: 1.31–2.62, P <0.001). Regression analysis identified a strong negative correlation between DKK1  expression and methylation of its promoter.
Conclusion: These findings support the hypothesis that elevated DKK1  expression is modulated via methylation of its promoter and indicate that DKK1  expression is a highly informative prognostic biomarker for patients with HNSCC.
Keywords: HNSCC, DKK1 , overall survival, prognosis, methylation