The Relationship between Forkhead Box M1 (FOXM1) Expression and Nasopharyngeal Carcinoma Stage

Abstract

Nasopharyngeal carcinoma (NPC) is a malignancy with a high incidence in Southeast Asia and is frequently diagnosed at an advanced stage. Forkhead box M1 (FOXM1) is a transcription factor involved in cell-cycle progression, proliferation, invasion, migration, and metastasis. Previous studies have reported FOXM1 overexpression in NPC and its association with tumor progression; however, its relationship with clinical stage remains unclear. To determine the association between Forkhead Box M1 (FOXM1) expression and the stage of nasopharyngeal carcinoma. This analytic observational study used a cross-sectional design and was conducted at the Otorhinolaryngology outpatient clinic of Adam Malik Hospital, Medan, from 2022 to 2024. The study population comprised patients with histopathologically confirmed nasopharyngeal carcinoma. A total of 39 patients who fulfilled the inclusion and exclusion criteria were enrolled using a non-probability consecutive sampling technique. Histopathological examination was performed at the Department of Anatomical Pathology, Adam Malik Hospital, Medan, while FOXM1 mRNA expression was assessed at the Integrated Laboratory, Faculty of Medicine, Universitas Sumatera Utara, using real-time reverse transcription polymerase chain reaction (RT-qPCR) and expressed as ΔCt values. Clinical stage was determined according to the American Joint Committee on Cancer (AJCC) 8th edition TNM classification. Data were analyzed using univariate and bivariate analyses, and the Kruskal–Wallis test was performed to assess the relationship between FOXM1 expression and clinical stage. Among the 39 patients, 28 (71.8%) were male, and the most common age group was 41–60 years (64.1%). Most patients had advanced disease, with T4 being the most frequent primary tumor category (46.2%). The mean FOXM1 ΔCt value was 7.05 ± 3.38, with a median of 6.01 and a range of −1.96 to 13.86. Median FOXM1 ΔCt values were 8.78 (4.98–12.52) in patients with stage II–III disease, 6.28 (−1.96–13.86) in stage IVA, and 5.39 (4.92–12.20) in stage IVB. Although ΔCt values decreased progressively with increasing clinical stage, indicating a trend toward higher FOXM1 expression in advanced disease, the difference was not statistically significant (p = 0.140). There was no statistically significant relationship between FOXM1 mRNA expression and clinical stage of nasopharyngeal carcinoma. However, the progressive decrease in ΔCt values from earlier to more advanced stages suggests a potential trend toward increased FOXM1 expression with disease progression.