Expression of Epithelial Cell Adhesion Molecule (EpCAM) in Oral Squamous Cell Carcinoma and Its Correlation With Clinicopathological Features: A Pilot Study From Northeast India.

backgroundOral squamous cell carcinoma (OSCC) poses a major public health burden in South Asia, particularly in Northeast India, where exposure to smokeless tobacco and areca nut is highly prevalent. Epithelial cell adhesion molecule (EpCAM), a transmembrane glycoprotein involved in tumour proliferation and signalling pathways, has been implicated in the pathogenesis across multiple epithelial malignancies. This pilot study aimed to evaluate the immunohistochemical expression pattern of EpCAM in OSCC and to explore its association with clinicopathological parameters.

methodsA hospital-based cross-sectional pilot study was conducted at the Department of Pathology, Jorhat Medical College and Hospital, Jorhat, Assam, India, from December 2024 to November 2025. Thirty-five biopsy-confirmed cases of OSCC were included. All specimens underwent routine haematoxylin and eosin (H&E) histopathological examination, followed by manual immunohistochemistry (IHC) staining with a monoclonal anti-EpCAM antibody (anti-EpCAM, clone BerEP4, PathnSitu, prediluted, ready to use). Staining was scored using a composite score (intensity 0-3 x proportion 0-4; total 0-12), with overexpression defined as a total score >4. Statistical associations were examined using Fisher's exact test (Statistical Product and Service Solutions (SPSS, version 26.0; IBM SPSS Statistics for Windows, Armonk, NY); significance level α = 0.05. Effect sizes were estimated using odds ratios (OR) with 95% confidence intervals (CI).

resultsThe study population included 21 males and 14 females (male-to-female ratio 1.5:1), with a mean age of 54.8 years and a peak age group of 51-60 years. Buccal mucosa was the most frequent tumour site (37%), followed by alveolar mucosa (23%) and tongue (20%). Histologically, 24 cases (68.6%) were well-differentiated, 9 (25.7%) moderately differentiated, and 2 (5.7%) poorly differentiated. EpCAM overexpression (total score: >4) was observed in 10 of 35 cases (28.6%), weak expression (score: 1-4) in 12 cases (34.3%), and no expression in 13 cases (37.1%). Overall, EpCAM overexpression was observed in 28.6% of cases. A significant association was found between EpCAM overexpression and histological grade (p = 0.008), with moderately and poorly differentiated tumours demonstrating higher odds of overexpression compared to well-differentiated tumours (OR = 12.25; 95% CI: 2.18-68.6). Among other clinicopathological parameters, overexpression was more frequently observed in males (38.1% vs 14.3% in females), alcohol users (57.1% of exclusive alcohol users), and tongue carcinomas (57.1% of tongue cases); however, these associations were not statistically significant.

conclusionEpCAM overexpression was detected in approximately 28.6% of OSCC cases in this Northeast Indian cohort. The observed trends suggest increased EpCAM overexpression in males, those with alcohol consumption, and tongue carcinomas, while a significant association was observed with higher histological grade. This pilot study is limited by a small sample size and a lack of TNM staging and survival data, restricting prognostic interpretation. These findings should be considered preliminary and exploratory in nature. Larger prospective multi-centre studies are needed to validate these observations and determine the prognostic and therapeutic relevance of EpCAM in OSCC.