Correlation of total VEGF mRNA and protein expression with histologic type, tumor angiogenesis, patient survival and timing of relapse in non-small-cell lung cancer

We have quantified the expression of all 4 isoforms of vascular endothelial growth factor (VEGF) mRNA in non-small-cell lung cancer (NSCLC) using a new kinetic quantitative PCR method, real-time quantitative (RTQ) RT-PCR, and investigated the association between VEGF expression at the mRNA and protein levels and the clinicopathologic variables, tumor angiogenesis, patient survival and timing of relapse. Surgical tumor specimens from 72 NCSLC patients (37 squamous-cell carcinomas, 35 adenocarcinomas) were examined. Twenty-eight patients had stage I, 10 stage II and 34 stage IIIA or IIIB disease. Total VEGF mRNA (all 4 isoforms) was quantified by RTQ RT-PCR, while VEGF protein expression and microvessel number in tumors were assessed immunohistochemically. VEGF mRNA was detected in all 72 tumor samples at significantly higher levels than in adjacent normal tissue. Tumoral VEGF mRNA levels correlated strongly with the VEGF protein staining score and microvessel count. Adenocarcinomas showed significantly higher VEGF mRNA expression and a higher protein staining score than squamous-cell carcinomas. High tumoral VEGF mRNA expression was associated with advanced (IIIA or IIIB) tumor stage, lymph node metastasis, high tumoral microvessel counts, short patient survival (<24 months) and early relapse (<12 months), while a high VEGF protein staining score was associated with high tumoral microvessel counts, short patient survival and early relapse. Patients with high tumoral levels of both VEGF mRNA and protein had significantly shorter survival and earlier relapse. In multivariate analysis, the VEGF protein staining score and nodal status were the most important independent predictors of survival and recurrence. We conclude that RTQ RT-PCR is a sensitive method for detecting and quantifying VEGF mRNA expression in NSCLC and that the expression levels of total VEGF mRNA and protein in NSCLC are strongly associated with histologic type, tumor angiogenesis, survival and timing of relapse. High VEGF expression in adenocarcinomas may contribute to their greater metastatic potential.     

High expression of leptin receptor mRNA in breast cancer tissue predicts poor prognosis for patients with high, but not low, serum leptin levels

The association of mRNA expression levels of leptin receptors (long isoform: Lep-R(L) and short isoform: Lep-R(S)) in breast cancer tissue with patient prognosis was studied with special reference to the serum leptin level or the leptin mRNA level in tumor tissue. Lep-R(L), Lep-R(S) and leptin mRNA levels in breast cancer tissue (n = 91) were determined with a real-time PCR assay, and serum leptin levels in breast cancer patients (n = 67) with an enzyme-linked immunosorbent assay. Neither Lep-R(L) nor Lep-R(S) mRNA levels in tumor tissue were significantly associated with patient prognosis, but both intratumoral Lep-R(L) and Lep-R(S) mRNA high tumors were significantly (p < 0.01) associated with a poor prognosis. Multivariate analysis showed that a high level of both Lep-R (L) and Lep-R (S) mRNA in tumor tissue was a significant risk factor, independent of other risk factors. The subset analysis demonstrated that both intratumoral Lep-R(L) and Lep-R(S) mRNA high tumors were significantly associated with a poor prognosis for the subset of patients with high serum leptin or high intratumoral leptin mRNA levels but not in the subset of patients with low serum leptin or low intratumoral leptin mRNA levels. The association between both intratumoral Lep-R(L) and Lep-R(S) mRNA high tumors and a poor prognosis in the presence of high serum leptin or high intratumoral leptin mRNA levels seems to suggest that the leptin and Lep-R(L)/Lep-R(S) pathways are implicated in the growth stimulation of breast tumors. The well-established finding that obesity serves as a risk factor for relapse in breast cancer patients may thus be partially explained by the high serum leptin level seen in obese women.     

Interleukin-8 in non-small cell lung carcinoma: relation with angiogenic pattern and p53 alterations

Progression of solid tumors, including NSCLC, is associated with increase in MVC (microvessel count), as a measure of tumor angiogenesis resulting from an imbalance between angiogenic factors and inhibitors. However, since tumor angiogenesis is a multi-step process under the control of various molecules, the mechanism of angiogenesis has not been fully clarified. Interleukin (IL)-8 has been shown to have a potential angiogenic effect in vitro and in vivo, and is overexpressed in several human solid cancers. Among the various angiogenic factors, vascular endothelial growth factor (VEGF) has been shown to correlate with a high MVC and with adverse prognosis in several human cancers, including NSCLC. Alterations of p53 suppressor gene are the most common genetic changes found in malignant tumors; several studies examined the link between aberrant p53 and angiogenesis in lung cancer, but only a few studies report data regarding a relation between p53 mutations and IL-8 expression. In this study we observed a correlation between IL-8 mRNA expression, intratumoral MVC and VEGF mRNA expression levels; furthermore, an aberrant p53 status was related to IL-8 expression. However, in our samples IL-8 levels did not significantly affect prognosis of NSCLC; more studies are required to elucidate the precise role of IL-8 in a large series of patients with non-small cell lung carcinoma.     

Matrix metalloproteinase-2 status in stromal fibroblasts, not in tumor cells, is a significant prognostic factor in non-small-cell lung cancer.

PURPOSE: The purpose is to assess clinical significance of matrix metalloproteinase (MMP)-2 and MMP-9 status, especially MMP-2 status, in stromal cells in non-small-cell lung cancer (NSCLC) because experimental studies have revealed that stromal MMP-2 plays important roles in progression of malignant tumors, but most clinical studies focused on tumoral MMP-2 expression, not stromal MMP-2 expression. EXPERIMENTAL DESIGN: We conducted a retrospective study on MMP-2 and MMP-9 expression as evaluated immunohistochemically in a total of 218 consecutive patients with completely resected pathological stage I-IIIA, NSCLC. RESULTS: Strong MMP-2 expression in tumor cells and stromal fibroblasts were documented in 54 (24.8%) and 132 (60.6%) patients, respectively. Strong MMP-2 expression in stromal fibroblasts was more frequently seen in squamous cell carcinoma (72.7%) than in adenocarcinoma (54.9%; P = 0.016). Tumors showing strong MMP-2 expression in stromal fibroblasts showed a significantly higher intratumoral microvessel density (IMVD) than weak stromal MMP-2 tumors (mean intratumoral microvessel density, 50.9 versus 32.4, P = 0.003). In addition, postoperative prognosis of strong stromal MMP-2 patients was significantly poorer than that of weak stromal MMP-2 patients (5-year survival rate, 77.5 versus 60.2%, P = 0.032), and the prognostic significance was enhanced in squamous cell carcinoma patients but disappeared in adenocarcinoma patients. Multivariate analyses confirmed that strong stromal MMP-2 expression was a significant factor to predict a poor prognosis in squamous cell carcinoma patients, not in adenocarcinoma patients. In contrast, MMP-2 or MMP-9 status in tumor cells was not a significant prognostic factor. CONCLUSIONS: MMP-2 status in stromal fibroblasts, not in tumor cells, was a significant prognostic factor associated with angiogenesis in NSCLC.     

Quantitative analysis of carbonic anhydrase IX mRNA in human non-small cell lung cancer

Hypoxia is associated with malignant progression and poor outcome in human cancers. The effects of hypoxia are mediated by a series of genomic changes that enable tumor cells to survive or escape their oxygen deficient environment. Recent studies indicated that carbonic anhydrase IX (CA IX) is an intrinsic marker of hypoxia. In the present study we investigated with quantitative RT-PCR the expression of CA IX mRNA in 93 non-small cell lung carcinomas (NSCLC) and in their paired not affected tissues. CA IX mRNA was expressed in 100% NSCLC and in 76% of paired not affected tissues, even if tumoral CA IX expression was found constantly higher (p < 0.02) than that found in normal tissues. The increase of CA IX mRNA expression in cancer tissues was significantly correlated to the increase of corresponding protein, as determined with conventional immunoblotting (p = 0.027). In addition the expression of CA IX mRNA in NSCLC samples was significantly correlated to VEGF (p = 0.002) and MMP-9 (p = 0.002) mRNAs. Whereas CA IX mRNA expression was not associated to any clinical-pathological parameters in our patients, global survival analysis of cancer-related death revealed that high expression of CA IX mRNA predicted unfavorable outcome (p = 0.001) and shorter disease free survival interval (p = 0.004). A multivariate analysis showed that CA IX expression was the strongest prognostic parameter (p = 0.000) in comparison to other conventional predictive markers. In addition, differences emerged on the basis of clinical-pathological parameters: in fact separate Kaplan-Meyer analyses of patients indicated that whereas high levels of CA IX mRNA expression were not predictive of worse prognosis in early NSCLC (G1, T1, Stage 1 and pN- patients), this parameter appeared highly significant in advanced NSCLC (G2-G3, T2-T3, Stage 2-3 and pN+ patients). Finally we demonstrated that CA IX expression was not able to discriminate different survival probability in adenocarcinomas, whereas the same parameter was highly predictive in squamous (p = 0.03) and adenosquamous cell carcinomas (p = 0.001).     

VIP增强VEGF mRNA在非小细胞肺癌细胞中的表达

背景与目的研究发现血管内皮生长因子(VEGF)和血管活性肠肽(VIP)均对肿瘤的生长具有促进作用,但VIP通过何种方式来促进肿瘤的生长还不清楚。本研究的目的是观察VIP对非小细胞肺癌(NSCLC)细胞中VEGFmRNA表达的影响。方法应用反转录聚合酶链式反应(RTPCR)技术检测VEGFmRNA在NSCLC细胞系和小细胞肺癌(SCLC)细胞系中的表达及VIP对其表达的影响。结果在NSCLC细胞系A549、GLC82、H157、H460和SCLC细胞系H446中检测到了VEGFmRNA的表达。VIP能促进VEGFmRNA在A549和H157细胞中的表达,在VIP作用8h和16h时,VEGFmRNA的表达水平达到最高,显著高于VIP作用0h时(P<0.01)。结论VIP可能通过增强VEGFmRNA在肺癌细胞中的表达和分泌,促进肺癌新生血管的生成,参与肿瘤的生长。     

Correlation between cyclooxygenase-2 and tumor angiogenesis in non-small cell lung cancer

The role of COX-2 expression and angiogenesis of lung cancer is yet to be delineated. Eighty four non-small cell lung cancer (NSCLC) specimens were evaluated for COX-2 expression, microvessel density (MVD), and vascular endothelial growth factor (VEGF) expression by immunohistochemical methods. The relationships between COX-2 expression and MVD, VEGF expression, and survival time were analyzed. COX-2 expression was observed in the cytoplasm and membrane of the carcinoma cells, and premalignant cells. COX-2 was positive in 67 cases (79.8%). There was a statistically significant correlation between COX-2 expression and tumor size, TNM stage, tumor type, VEGF expression, and vascular pattern with survival in univariate analysis. No significant correlation was seen between COX-2, VEGF expression and MVD. A lack of expression of either COX-2 or VEGF expression or both, however, was associated with lower MVD than the group with both expressed. The difference was statistically significant (P=0.005). Statistically significant differences were also observed according to TNM stage, vascular pattern, COX-2 expression, and VEGF expression. With multivariate analysis, only TNM stage and COX-2 expression retained their significance as independent predictors of survival. COX-2 expression takes part in tumor angiogenesis and is a significant poor prognostic factor in the surgically resected NSCLC. COX-2 inhibitor, either in combination therapy with other agents, or for chemoprevention, may be effective via suppression of angiogenesis in this fatal disease.     

Role of cyclooxygenase-2 in immunomodulation and prognosis of endometrial carcinoma

Although there are several hypotheses explaining the mechanisms of immune-privileged status of malignant tumor, the exact pathway has yet to be explored. Cyclooxygenase (COX)-2 plays a vital role in prognosis of cancer patients in terms of contribution to neoangiogenesis and apoptosis inhibition; however, the impact of COX-2 in immunomodulation has not been reported. We have evaluated the expression of COX-2 and its impact on infiltration of immune-competent cells into the tumor cell nest in endometrial carcinoma. Tissue specimens from 70 endometrial carcinoma patients who had undergone a curative resection were evaluated for COX-2 expression and host immune status (CD8+ T cells). COX-2 expression was associated with FIGO stage and myometrial invasion, but there was no statistically significant impact. CD8+ T cells within cancer cell nest (Nest CD8) were inversely correlated with the expression level of COX-2 (p = 0.0006). Nest CD8 became an independent predictor of patient survival (Hazard ratio = 10.300, p = 0.0304) in Cox's multivariate analysis. The expression level of COX-2 was found to be a significant predictor of disease relapse in univariate analysis (p = 0.0294) but not in multivariate analysis (p = 0.5949). In conclusion, increased nest CD8 produced a survival advantage in endometrial carcinoma patients. Moreover, tumor-produced COX-2, which reduces the infiltration of CD8+ T cells into cancer cell nests, may allow tumors to avoid immune surveillance.     

Angiogenesis in gastric cancer: importance of the thymidine phosphorylase expression of cancer cells as an angiogenic factor

Thymidine phosphorylase (TP) has been reported to stimulate angiogenesis in a variety of human malignancies. We investigated TP expression and its association with angiogenesis in 73 cases of resected gastric cancer. In addition, we compared the expression of the other angiogenesis related factors (VEGF, eNOS and p53) with that of TP with respect to angiogenesis. TP expression was not detected in most of the non-tumoral glandular epithelial cells except for 5 cases. TP expression of the cancer cells and the stroma was assessed separately. The stromal TP expression was not associated with the TP expression of the cancer cells. The mean percent of TP reactive cancer cells was 18.36+/-2.61 (median, 10.00; range, 0-90) and cases showing a percentage higher than the mean were considered as bearing high reactivity. The mean microvessel score assessed was 90.44+/-3.69 (median, 86; range, 31-174). The TP expression of cancer cells was strongly associated with microvessel density (p=0.030), but the stromal TP expression was not. The microvessel density of the tumor showed strong correlation with VEGF expression (p<0.001), but a marginally significant association with eNOS (p=0.055). On the contrary, there was no association with p53 expression and microvessel density of the tumor. No significant correlation was detected between lymph node metastasis and tumoral or stromal TP expression or VEGF/TP coexpression. In gastric cancer, TP expression of the cancer cells, not stromal cells may play an important role in tumor growth by microvessel formation.     

Clinical significance of VEGF-C status in tumour cells and stromal macrophages in non-small cell lung cancer patients

Recent experimental studies have revealed that tumour-associated stromal macrophages as well as tumour cells express vascular endothelial growth factor C (VEGF-C), which plays important roles in lymphangiogenesis, which is a critical factor in the progression of many malignant tumours including non-small-cell lung cancer (NSCLC). However, no clinical study on VEGF-C expression in both stromal macrophages and tumour cells has been reported, and we conducted the present study to address the issue in resected NSCLC. A total of 206 patients with completely resected pathologic stage I-IIIA NSCLC were retrospectively reviewed. Expression of VEGF-C in primary lung tumour was assessed immunohistochemically. Expression of VEGF-C in tumour cells was high in 125 patients (60.7%), and that in stromal macrophages was positive in 136 patients (71.2%). The status of VEGF-C in tumour cells or in stromal macrophages was not correlated with nodal status or angiogenesis. The 5-year survival rate of high tumoral VEGF-C patients (60.7%) was significantly lower than that of low tumoral VEGF-C patients (39.3%) (P=0.046), and a multivariate analysis confirmed that tumoral VEGF-C status was a significant and independent prognostic factor. Moreover, tumour showing high VEGF-A and VEGF-C expression in tumour cells showed the poorest prognosis (5-year survival rate, 45.1%). The status of VEGF-C in stromal macrophages was not correlated with the prognosis. In conclusion, tumoral VEGF-C status, not stromal VEGF-C status, was a significant prognostic factor in resected NSCLC.     

Association between cyclooxygenase-2 and matrix metalloproteinase-2 expression in non-small cell lung cancer

BACKGROUND: Cyclooxygenase-2 (COX-2) contributes to invasiveness of cancer through activation of several matrix metalloproteinases (MMPs). Matrix metalloproteinase-2 (MMP-2) is a proteolytic enzyme that degrades the extracellular matrix, and has been linked to invasion and metastasis. This study aims to assess the correlation of the COX-2 expression and the MMP-2 expression in patients with non-small cell lung cancer (NSCLC). METHODS: We analyzed the protein expressions of COX-2 and MMP-2 by immunohistochemical staining on the tissue array specimens from 204 patients with completely resected NSCLC. A <10% immunostaining of the cancer cells was considered negative, while >10% was considered positive. RESULTS: The COX-2 expression was positive in 68.1% and that of the MMP-2 was positive in 45.6%. The positive expression rate of MMP-2 (52.5%) in the positive COX-2 group was higher than that in the negative COX-2 group (30.8%, P = 0.004). Furthermore, the MMP-2 expression was associated with lymph node involvement, the tumor stage and the histological type. The patients with a positive MMP-2 expression showed a reduced survival (P = 0.048). CONCLUSIONS: The COX-2 expression is associated with the MMP-2 expression in NSCLC patients: the latter may also be associated with tumor progression and reduced survival in NSCLC patients.     

p21^WAF1和VEGF在非小细胞肺癌中的表达及临床相关性研究

目的 研究p21WAFI和血管内皮生长因子的表达和肿瘤内微血管密度测定在非小细胞肺癌中的意义。方法用免疫组化方法对45例非小细胞肺癌患者经纤支镜活检、经皮肺活检取得的标本检测p21WAFI和VEGF的表达,并用CD31抗体标记癌组织血管内皮细胞,计算MVD。结果 p21WAFI和VEGF阳性表达率分别为68.9％和77.8％;二者的表达和MVD均与性别、病理类型无关(P>0.05),与临床分期、癌组织MVD呈正相关(P<0.05);p21WAFI阳性、VEGF阴性组的中位生存期(14个月)与p21WAFI阴性、VEGF阳性组的中位生存期(11个月)相比,差异无显著性(P>0.05);p21WAFI阳性、VEGF阳性组的中位生存期(10个月)与p21WAFI阴性、VEGF阴性组的中位生存期(15个月)相比,差异无显著性(P>0.05)。结论p21WAFI和VEGF在非小细胞肺癌的发生和发展中起着重要作用,可反映非小细胞肺癌的恶性程度和进展情况。作为预后指标,p21WAFI作用的发挥是通过上调VEGF的表达水平来实现的,VEGF的表达对肿瘤血管形成、转移起重要作用。     

STMN 1m RNA在非小细胞肺癌中的表达与紫杉醇类药物化疗效果和患者生存率的关系

目的：RT－PCR法检测STMN1 mRNA在非小细胞肺癌石蜡组织中的表达与患者紫杉醇治疗疗效以及生存率的关系。方法：RT－PCR法检测135例非小细胞肺癌及20例正常肺组织中STMN1 mRNA的表达,探讨STMN1 mRNA表达水平与紫杉醇类药物化疗效果的关系。通过随访STMN1 mRNA不同表达水平的患者,探讨STMN1 mRNA表达水平与患者生存率的关系。结果：STMN1 mRNA表达水平在肺癌组织中显著高于正常肺组织（P＝0．021）。STMN1 mRNA低表达患者无进展生存期为13．0个月,而高表达者为8．0个月（P＝0．037）。紫杉醇类化疗方案在STMN1 mRNA 高表达组中的疗效显著低于 STMN 1 mRNA 低表达组（P＝0．028）,而在无紫杉醇类化疗患者中,两组之间疗效评价差异没有显著性（P＝0．912）。结论：STMN1 mR-NA在肺癌组织中高表达。STMN1 mRNA高表达与较短的生存期相关,STMN1 mRNA表达水平与紫杉醇类药物化疗效果有关。mRNA高表达组的患者化疗疗效较差,提示STMN1 mRNA高表达对紫杉醇耐药。     

COX-2、VEGF在NSCLC中的表达及与微血管生成的关系

目的探讨肺癌组织中COX-2、VEGF的表达及与血管生成和临床病理特征的关系。方法收集85例肺癌和20例肺良性病变标本,免疫组化S-P法检测COX-2、VEGF蛋白及MVD的表达并作相关分析。结果COX-2、VEGF、MVD在肺癌中的阳性表达率显著高于肺良性病变组织(P<0.05);COX-2表达与肺癌的组织学类型、分化程度和淋巴结转移相关(P<0.05);VEGF表达与肺癌分化程度和淋巴结转移相关(P<0.05);COX-2、VEGF、MVD呈两两正相关。结论COX-2、VEGF参与了肺癌的发生发展过程,COX-2可能通过上调VEGF促进肺癌的血管新生和发生发展。     

血管内皮生长因子在非小细胞肺癌中的表达及临床意义

目的　研究血管内皮生长因子的表达与非小细胞肺癌临床病理特征及预后的关系 ,探讨血管内皮生长因子的作用机制。方法　采用超敏过氧化酶免疫组织化学法 ,检测手术切除的 96例非小细胞肺癌组织标本中微血管密度和血管内皮生长因子的表达。结果　 96例非小细胞肺癌组织标本中血管内皮生长因子的阳性表达率为 64 .6% ( 62 /96) ,主要分布于癌细胞的胞浆内 ,细胞核内无表达。VEGF表达与临床分期有密切关系 (P =0 .0 41) ,与其他各项临床病理特征无明显统计学相关性 (P >0 .0 5 )。微血管高密度组血管内皮生长因子阳性表达率为 80 .4% ,明显高于微血管低密度组 ( 4 6.7% ) (P =0 .0 0 1)。血管内皮生长因子阳性表达患者生存期明显短于阴性表达患者 (P <0 .0 1)。Cox风险比例模型分析显示血管内皮生长因子表达和病理分期可作为判断非小细胞肺癌患者预后的独立指标。结论　血管内皮生长因子可引起瘤内微血管密度增加 ,在非小细胞肺癌血管形成中起重要作用 ,并有助于预测肺癌患者预后。     

The validation of estrogen receptor 1 mRNA expression as a predictor of outcome in patients with metastatic non‐small cell lung cancer

The prognostic role of estrogen receptors in lung cancer is not validated. Results from patients with early stage non‐small lung cancer patients indicate a prognostic role of estrogen receptor 1 (ESR1) mRNA expression in these patients. Automated RNA extraction from paraffin and RT‐quantitative PCR was used for evaluation of tumoral ESR1 and progesterone receptor (PGR) mRNA expression. The test cohort consisted of 31 patients with advanced or metastatic non‐small cell lung cancer (NSCLC) patients, treated in a first‐line registry trial. For validation, 53 patients from a randomized multicentre first‐line study with eligible tumor samples were evaluated. There was no significant correlation of ESR1 expression with clinical characteristics. ESR1 high expression was of significant positive prognostic value in the training set with a median overall survival (OS) of 15.9 versus 6.2 months for high versus low ESR1 expression patients (p = 0.0498, HR 0.39). This could be confirmed in the validation cohort with a median OS of 10.9 versus 5.0 months in ESR1 high versus low patients, respectively (p = 0.0321, HR 0.51). In the multivariate analysis adjusted for histological subtype, gender, age and performance status, ESR1 expression remained an independent prognostic parameter for survival in both cohorts. In contrast to ESR1, PGR expression was not able to separate prognostic groups or to predict outcome significantly (for OS; p = 0.94). Our study shows that ESR1 mRNA as assessed by qPCR represents a reliable method for detecting ESR1 expression in NSCLC and that ESR1 expression is an independent prognostic factor in metastatic NSCLC.