2.1. Patient characteristics and tumor samples
A total of 50 formalin-fixed paraffin-embedded tissues from LSCC samples (signet ring cell and intestinal subtypes) were collected from the pathology lab of Rasoule-e-Akram hospital, Tehran, Iran, from 2019 to 2018. The patients with primary LSCC who had undergone laryngectomy surgery but had not received either chemotherapy or radiotherapy were included. Besides, the hematoxylin and eosin (H & E) stained slides and medical records of enrolled patients were collected to acquire clinicopathological data including gender, age, tumor size, differentiation, TNM stage, lymph node involvement, perineural invasion, and lymphovascular invasion.
2.2. Tissue microarray (TMA) construction
Concisely, the most representative regions of tumor and normal were selected by an expert pathologist (N.S.) through assessing hematoxylin and eosin slides. Then, using precision arraying equipment (Tissue Arrayer Mini core; ALPHELYS, Plaisir, France), a core of 0.6 mm diameter was removed from the selected areas in each donor block and transferred to a new recipient paraffin block. In the current study, three cores were punched and assessed from each tumor and scored separately. TMA slides were obtained by cutting sections of TMA blocks to a thickness of about 4 micrometers, which were transferred to an adhesive slides system (SuperFrost Plus, Termo Scientifc™, Germany). Next, TMA blocks were constructed in three copies for each specimen. In order to increase the accuracy and validity, the mean overall histochemical score (H score) value of three cores was calculated as final scores.
2.3. Immunohistochemistry staining
The expression of IDH1 at the protein level was assessed using TMA-based IHC. There have been multiple processes to do IHC. In the first step, all the slides were deparaffinized after 30 min at 60°C and then rehydrated in xylene and serial ethanol dilutions. In order to blockage of endogenous peroxidase activity, H202 0.3% was used for 20 min at room temperature. After washing the tissue sections three times in Tris Buffered Saline (TBS), antigen retrieval was executed by covering the tissues in Tris/EDTA (pH 9.0) for 10 min in an autoclave.
Consequently, all tissue sections were incubated with the primary antibody specific to IDH1 (1:500 dilution, Abcam: ab109215, Cambridge, UK) for one overnight at 4°C. The next day, after three times washing in TBS for visualizing bound antibody-antigen, TMA slides were incubated with the secondary antibody (Envision, standard Envision HRP kit, Biopharmadx) for 30 min and then 3, 30-diaminobenzidine as chromogen (DAB, Dako, Glostrup, Denmark). Then, for visualization of the antigen, TMA sections were incubated with hematoxylin (Dako, Glostrup, Denmark). Finally, the tissues slides were dehydrated in alcohol, washed in xylenes, and prepared for scoring by pathologists. The normal liver tissue was applied as the positive control while, for the negative control, TBS was utilized in place of the primary antibody. Besides, rabbit immunoglobulin IgG (Invitrogen, Thermo Fisher Scientific, Waltham, MA, USA) was used as an isotype control test.
2.4. Evaluation of immunostaining
The staining of IDH1 on TMA LSCC sections were assessed by the pathologist (N.S.) by applying a semi-quantitative scoring system that is blinded to the clinicopathological characteristics of the patients. There are three scoring systems that are utilized for the expression of IDH1, namely the intensity of staining, the percentage of positive tumor cells, and the H-score. The intensity of staining ranging from 0 to 3 scores as follows: 0 = negative or non-staining, 1 = weak, 2 = moderate, and 3 = strong. The percentage of positive cells was classified into four groups comprising Group 1:<25% positive cells, Group 2: 25–50% positive cells, Group 3: 51–75% positive cells, and Group 4:>75% positive cells. Finally, the histochemical score (H score) was attained by multiplying the staining intensity in the percentage of positive tumor cells, ranging from 0 to 300. In this study, the H-scores were categorized into two groups, including 0-200 as the low expression group and 201–300 as the high expression group.
2.5. Statistical analysis
The analysis of all data were performed by the “statistical software SPSS, version 25.0 (SPSS, Inc., IBM Corp, USA). The categorical and quantitative data were reported by N (%) as valid percent and mean (SD) or median (Q1, Q3), respectively. Pearson’s χ2 test was applied to analyze the association and correlation between IDH1 protein expression and clinicopathological parameters. Furthermore, the pairwise comparison between the groups of the study was executed by Kruskal–Wallis, and Mann–Whitney U tests. The statistically significant difference in all sections was considered as p < 0.05.