Evaluation of The Prognostic Role of Sox2 as A Tumor Stem Cell Marker in Odontogenic Cysts and Tumors: Clinical, Radiographic and Immunohistochemical Correlation

Background Odontogenic cysts and tumors are highly encountered jaw lesions with varying clinical characteristics and disease behavior. Its pathogenesis may involve the existence of tumor stem cells. SOX2 transcription factor is expressed in embryonic and adult stem cells and exerts a potent influence on maintaining pluripotency. SOX2 expressing cells would account for the aggressive nature and recurrence of some odontogenic pathologies. To evaluate the prognostic role of SOX2 stem cell marker in odontogenic cysts and tumors and determine whether its expression is associated with the clinico-biological behavior of these lesions, this study aimed to assess the immunoexpression of the stem cell marker SOX2 in ameloblastoma, odontogenic keratocyst and dentigerous cyst and correlate SOX2 immunohistochemical staining scores to clinical and radiographic findings and recurrence of these lesions. Methods Forty-Five s urgical specimens were included in this study, 15 ameloblastomas (Ab), 15 odontogenic keratocysts (OKC) and 15 dentigerous cysts (DC). An immunohistochemical (IHC) study using the SOX2 Rabbit Polyclonal Antibody was done to evaluate SOX2 expression. A semi-quantitative method for subjectively scoring percentage and intensity of SOX2 staining was carried out. Statistical correlation to clinical data, radiological findings and recurrence were analyzed. Results Nuclear SOX2 expression was strong positive within OKC specimens in both basal and sub-basal layers, followed by Ameloblastoma which showed nuclear and cytoplasmic reaction, while most cases of DC recorded low positive scores. Significant difference in SOX2 (IHC) staining scores was found between (OKC) and (DC) (P = < 0.001*), as well as between (Ab) and (DC) (P = 0.012*), (OKC) showed a significant higher SOX2 expression than ameloblastoma (P = 0.048*). A significant positive correlation was found between SOX2 expression and both cortical bone perforation and recurrence (P = 0.040*, 0.001*), while no significant correlation to age, gender, root resorption or radiographic loculation (P = 0.874, 0.162, 0.062, 0.137). Conclusion SOX2 is a reliable marker for tumor stem cells (TSCs) within benign odontogenic lesions. Positive correlation of SOX2 expression to cortical bone perforation and recurrence of these lesions point to the aggressive biological behavior, clinical outcome and poor prognosis. The prognostic role of SOX2 is of great value to improve treatment of odontogenic lesions. Trial registration This study was registered in ClinicalTrials.gov PRS (https//register.clinicaltrials.gov) under identification number NCT06833840 on 01/21/2025.