A 50% increase in mutational burden was documented in subsequent MEC tumors, and this was associated with increased expression of tumor-promoting genes (<i>MT1E, LGR5</i>, and <i>LEF1</i>), decreased expression of tumor-suppressor genes (<i>CDKN2B, SIK1</i>, and <i>TP53</i>), and higher expression of CSC-related proteins such as SOX2, MYC, and ALDH1A1.
By immunohistochemistry staining and survival analysis, a combination of CD44/CD133/SOX2 was found to have the strongest prognostic value for palatal MEC patients.