The presence of retraction clefts correlates with lymphovascular invasion and lymph node metastasis and predicts poor outcome: Analysis of 2497 breast cancer patients

Some invasive breast carcinomas are surrounded by a clear space that separate the tumor cells from the adjacent stroma, similar to invasive micropapillary carcinoma (IMPC), but lack the thin strands of connective tissue that separate the cells and characteristic “inside-out” growth pattern of IMPC on immunohistochemical stain for EMA. We consider the presence of the retraction clefts a common phenomenon that may present as a precursor stage of IMPC (PSIMPC). In this study, a total of 2497 cases of invasive breast carcinomas were prospectively collected. Among 2497 cases of breast cancer, 949 (38.0 %) cases were PSIMPC, 200 (8.0 %) cases were IMPC and 1348 (54.0 %) cases were IBC-NST. LVI was seen in128 of 200 (64 %) IMPC and 364 of 948 (38.0 %) PSIMPC, in contrast to 246 of 1341 (18 %) IBC-NST (P < 0.001). Lymph node metastasis was seen in 147 of 200 (73.4 %) IMPC and 551 of 949 (58 %) PSIMPC, in contrast to 563 of 1345 (42 %) IBC-NST (P < 0.001). The 5-year disease-free survival (DFS) and overall survival (OS) of PSIMPC were 76.8 % and 87.6 %, compared to 63.2 % and 85.9 % in IMPC, 86.2 % and 93.7 % in IBC-NST. PSIMPC demonstrated a more favorable DFS and OS compared to IMPC, but worse DFS and OS compared to IBC-NST. Cox and logistic regression analysis showed that PSIMPC was an independent predictor of DFS and OS. Our findings suggest that the presence of retraction clefts is a precursor state of IMPC, exhibiting IMPC-like features, such as higher incidence of lymphovascular invasion, lymph node metastasis and more aggressive clinical behavior.     

乳腺癌组织中LVD、VEGF-C和MMP-9表达及其相关性

目的 检测乳腺浸润性导管癌(invasive ductal carcinoma,IDC)组织中的淋巴管密度(lymphatic vessel density,LVD)、VEGF-C及MMP-9的表达,探讨其临床意义.方法 收集80例乳腺IDC和20例乳腺增生性病变,应用免疫组化PV-6000两步法检测淋巴管内皮透明质酸受体1(LYVE-1)、VEGF-C和MMP-9的表达.结果 乳腺癌组织中LYVE-1标记的LVD、VEGF-C和MMP-9的表达明显高于乳腺增生性病变,差异均有统计学意义(P<0.01).LVD、VEGF-C与临床病理参数之间均无差异(P>0.05).MMP-9的表达水平在肿瘤直径>2 cm组和淋巴结转移阳性组明显升高(P<0.05和P<0.01);而在组织学分级之间表达的差异无统计学意义(P>0.05).LVD与VEGF-C的表达呈正相关关系(r=0.398,P<0.01);LVD和MMP-9之间无相关关系(P>0.05).结论 IDC中淋巴管生成增多,VEGF-C是乳腺癌中淋巴管生成的重要刺激因子,促进乳腺癌中淋巴管的生成;但乳腺癌淋巴管密度与淋巴道转移无关.MMP-9参与肿瘤的侵袭和转移的过程,促进乳腺癌淋巴道转移.     

Low D2-40 immunoreactivity correlates with lymphatic invasion and nodal metastasis in early-stage squamous cell carcinoma of the uterine cervix.

Lymphatic invasion and nodal metastasis are predictors of shorter disease-free and overall survival in carcinoma of the uterine cervix. The monoclonal antibody D2-40, which reacts with the oncofetal membrane antigen M2A, is a new selective marker for lymphatic endothelium, and has been shown to be useful in identifying the presence of lymphatic invasion in various malignant neoplasms, including cervical carcinoma. However, the reactivity of the tumor cells with D2-40 has not yet been evaluated. In this study, we examined the pattern of D2-40 immunoreactivity in a series of 138 invasive squamous cell carcinomas of the uterine cervix. We correlated the presence and extent of D2-40 immunoreactivity in the tumor cells with various clinicopathologic features, the presence of lymphatic invasion, lymph node metastasis and outcome. Diffuse or focal D2-40 immunoreactivity was present in 17 (12%) and 81 (59%) tumors, respectively, while 40 (29%) tumors showed no immunoreactivity. Lymphatic invasion and nodal metastasis were present in 56 and 29% of tumors, respectively. Tumor emboli within lymphatic spaces and metastatic tumor foci in lymph nodes showed no immunoreactivity in 86 and 80% of the cases, respectively. Lymphatic invasion and nodal metastasis were significantly more common in tumors showing low D2-40 immunoreactivity (P<0.0001 and 0.022, respectively). D2-40 immunoreactivity showed no correlation with any other clinicopathologic features examined, including tumor size, grade and FIGO stage. In univariate analysis low D2-40 immunoreactivity was significantly associated with shorter recurrence-free, but not with overall survival. Our studies suggest that D2-40 immunostaining may serve as a marker for increased risk of lymphatic invasion and tumor recurrence in cervical biopsy material. Further study of the biological function of the M2A antigen may shed some light on the interaction of tumor cells with lymphatics.     

Phosphorylated mTOR expression correlates with poor outcome in early-stage triple negative breast carcinomas

The mammalian target of rapamycin (mTOR) plays an important role in cell growth, proliferation, and metabolism. Some studies have associated phosphorylated mTOR (p-mTOR) expression with worse outcome in breast cancers. However, the significance of p-mTOR expression specifically in triple negative breast carcinoma (TNBC) is unknown. In this study, p-mTOR expression was evaluated by immunohistochemistry in 172 TNBCs and the result was correlated with clinicopathologic variables and disease outcome. The majority of tumors (72.1%) were p-mTOR positive; p-mTOR expression did not correlate with age, tumor size, grade, lymph node status, or tumor stage. In patients at stage 1 and 2 disease, those with p-mTOR expression had significantly worse overall as well as recurrence-free survival compared to those without p-mTOR expression. p-mTOR expression appears to be an adverse prognostic indicator in early-stage TNBCs. The assessment of p-mTOR expression in these tumors may also help to stratify patients for future target therapy studies.     

甲状腺滤泡状癌微淋巴管密度与淋巴结转移的关系

目的: 应用新型淋巴管内皮标记物D2-40分析甲状腺滤泡状癌及周围组织微淋巴管密度(MLVD)与淋巴结转移之间的关系.方法: 应用免疫组织化学Envision法检测35例甲状腺滤泡状癌和20例结节性甲状腺肿中D2-40和CD34的表达, 分别计数MLVD和微血管密度(MVD), 分析MLVD与甲状腺滤泡状癌淋巴结转移之间的关系, 同时与病变中MVD行对比观察.结果: 甲状腺滤泡状癌周围结缔组织及被膜中的MLVD和MVD与淋巴结转移有密切关系;MLVD和MVD越高淋巴结转移率越高.同时甲状腺淋巴管内的癌栓与淋巴结转移也显著相关(P<0.01).结论: 甲状腺滤泡状癌的淋巴结转移与微淋巴管及微血管的形成有密切关系, 抑制淋巴管生成, 这可能是未来甲状腺肿瘤治疗的一重要方向.     

Nuclear expression of N-cadherin correlates with poor prognosis of nasopharyngeal carcinoma

Luo W‐R, Wu A‐B, Fang W‐Y, Li S‐Y & Yao K‐T (2012) Histopathology  61, 237–246 Nuclear expression of N‐cadherin correlates with poor prognosis of nasopharyngeal carcinoma Aims: To investigate the aberrant expression of N‐cadherin in nasopharyngeal carcinoma (NPC) and its prognostic significance. Methods and results: Immunohistochemical staining for N‐cadherin protein was performed on tissue microarray (TMA) from 122 NPC patients. Cytoplasmic N‐cadherin was observed in 42.6% and nuclear N‐cadherin in 45.1% of NPC tissues. High expression of cytoplasmic and nuclear N‐cadherin was associated with a majority of the clinicopathological variables, including lymph node metastasis, distant metastasis and clinical stage. Cytoplasmic N‐cadherin was associated positively with nuclear N‐cadherin expression (P = 0.000). In univariate analysis, cytoplasmic N‐cadherin showed no significant impact on patient prognosis. In contrast, the overall survival was significantly shorter in patients with high nuclear N‐cadherin than those with low levels of staining (P = 0.002). A high expression of nuclear N‐cadherin predicted poorer survival in patients with late stage disease (P = 0.033), but not those with early tumour stage. In addition, multivariate analysis showed nuclear N‐cadherin to bean independent prognostic marker for NPC patients (P = 0.024). Conclusions: Nuclear N‐cadherin expression may represent a valuable prognostic marker in NPC patients, especially those with late stage disease.     

VEGF-C在食管癌中的表达及其与淋巴结转移相关性研究进展

食管癌是我国最常见的恶性肿瘤之一，早期即可发生淋巴结转移，是影响患者预后的重要因素。血管内皮生长因子-C（VEGF-C）目前被认为是唯一的特异性促进淋巴管生成的细胞因子，与肿瘤的淋巴结侵犯和转移密切相关，为近几年研究的热点。本文拟就VEGF-C与食管癌的淋巴管生成和淋巴结转移的相关性作一简要综述。     

ARP3 promotes tumor metastasis and predicts a poor prognosis in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Therefore, the study of the precise molecular mechanism underlying hepatocarcinogenesis has profound significance. In this study, we found that the expression of ARP3 was significantly up-regulated in HCC tissues and cell lines. Studies in liver cancer specimens showed that the expression of ARP3 is closely related to the pathological grade, distant metastasis and vascular invasion of HCC. According to the results of multivariate analysis, ARP3 is an independent prognostic factor for HCC patients. In vitro, knockdown of ARP3 expression significantly inhibited the invasion and migration of HCC cells and altered the expression of EMT markers. Based on the above conclusions, we conclude that ARP3 may be a potential prognostic indicator and therapeutic target for HCC patients.     

High expression of CRAM correlates with poor prognosis in patients with cervical carcinoma

Aims: Atypical chemokine receptors (ACRs) have been reported to scavenge or alter the localization of their chemokine ligands. However, CRAM, a newly identified ACR member, is lack of ligand scavenging properties. The present study was to investigate the clinical significance of CRAM in cervical carcinoma. Methods: The expression of CRAM in primary cervical cancer and paired normal tissues from adjacent regions was examined using Real time PCR. Moreover, CRAM protein expression was analyzed in 272 cervical specimens including 50 normal cervical tissues, 40 cases of carcinoma in situ of cervix (CIS), and 182 cases of cervical cancer by immunohistochemistry. Results: Real time PCR showed that the expression level of CRAM was markedly higher in cervical cancer than that in normal cervical tissues. The expression rate of CRAM in normal cervical tissues, CIS, and cervical cancer increased gradually (p < 0.01). In addition, the expression level of CCL19 was positively associated with that of CRAM (p < 0.05). Moreover, high expression level of CRAM was correlated with lymph node metastasis and histological subtype. In multivariate Cox regression analysis, high expression level of CRAM was a negative indicator for both overall (p = 0.028) and recurrence-free survival (p = 0.010). Conclusion: The present study suggested that CRAM could be a clinical prognostic marker for patients with cervical cancer and might be a potential therapeutic target for cervical cancer. Our data extended previous research on the predictive value of ACRs.     

VEGF-C在淋巴管生成及乳腺癌淋巴道转移中的作用

目的： 探讨阻断VEGF-C/Flt-4调控系统对淋巴管生成和乳腺癌淋巴道转移的影响。方法： 体外培养胎牛胸导管内皮细胞，观察VEGF-C和抗Flt-4抗体对淋巴管内皮细胞增殖的影响；设计合成VEGF-C反义脱氧寡核苷酸（ASODN），体外实验观察其对VEGF-C基因表达的影响；建立乳腺癌裸鼠原位移植瘤模型并观察ASODN对肿瘤淋巴管生成及肿瘤生长转移的影响。结果： 加入前列腺癌细胞PC3(高表达VEGF-C)上清后，淋巴管内皮细胞增殖活跃；加入抗Flt-4抗体后各时段细胞计数均明显少于其它各组。体外实验RT-PCR及 Western blotting显示ASODN作用的MCF-7细胞组VEGF-C mRNA及蛋白表达均低于对照组。体内RT-PCR检测表明ASODN组移植瘤VEGF-C mRNA表达明显受抑制；5-Nase-ALPase双重酶组织化学法结果显示ASODN组移植瘤的淋巴管生成明显减少；ASODN组肿瘤生长速度较对照组缓慢，且肿瘤体积、淋巴结转移明显低于对照组。结论： VEGF-C/Flt-4调控系统与乳腺癌组织的淋巴管生成及肿瘤的淋巴道转移密切相关。阻断淋巴管内皮细胞Flt-4表达，可在一定程度上抑制肿瘤细胞诱导的淋巴管内皮细胞增殖；ASODN通过下调乳腺癌VEGF-C的表达，减少肿瘤淋巴管的生成及淋巴结转移。     

Increased expression of miR-21 predicts poor prognosis in patients with hepatocellular carcinoma

Background: MicroRNAs (miRNAs) play critical roles in hepatocellular carcinoma (HCC) development and progression. Aberrant miR-21 expression has been reported in several cancers. However, the clinical significance of miR-21 in human HCC is still unclear. Methods: A total of 112 patients with primary HCC who underwent a curative liver resection were included in this retrospective study. The differentially expressed amount of the miR-21 was validated by quantitative real-time PCR (qRT-PCR). Survival rate was analyzed by log-rank test, and survival curves were plotted according to Kaplan-Meier. Multivariate analysis of the prognostic factors was performed with Cox regression model. Results: As revealed by qRT-PCR analysis, miR-21 expression was significantly upregulated in HCC tissues when compared with adjacent non-tumor tissues (P<0.05). High miR-21 expression level was observed to be closely correlated with tumor differentiation, TNM stage and vein invasion (P<0.05). Patients who had high miR-21 expression had a shorter overall survival than patients who had low miR-21 expression (P<0.05). Moreover, multivariate analysis of the prognosis factors with a Cox proportional hazards model showed that high miR-21 expression was a significant independent predictor of poor survival in HCC (P<0.05). Conclusion: Our results suggested that increased expression of miR-21 was significantly correlated with tumor progression and could be a novel potential biomarker for HCC prognosis.     

Aldehyde dehydrogenase 1 expression predicts poor prognosis in triple-negative breast cancer

Ohi Y, Umekita Y, Yoshioka T, Souda M, Rai Y, Sagara Y, Sagara Y, Sagara Y & Tanimoto A
(2011) Histopathology 59 , 776–780 Aldehyde dehydrogenase 1 expression predicts poor prognosis in triple‐negative breast cancer Aims: Aldehyde dehydrogenase 1 (ALDH1) has been identified as a reliable marker of breast cancer stem cells, and its clinical significance as a prognostic indicator of breast cancer has been reported by several investigators. However, the clinical significance of ALDH1 expression in triple‐negative (TN) breast cancer, a high‐risk breast cancer lacking the benefit of specific therapy, remains to be solved. Methods and results: We performed immunohistochemical analyses of 106 TN breast cancers, using paraffin‐embedded sections. The basal‐like phenotype was also investigated with the use of basal cytokeratin 5/6 and epidermal growth factor receptor. ALDH1 expression in carcinoma cells was found in 59% of cases and was correlated with high histological grade alone (P < 0.006), whereas ALDH1 expression in stromal cells was found in 49% of cases but was not correlated with any clinicopathological parameter. Patients with ALDH1 expression in carcinoma cells had a shorter relapse‐free survival (RFS) according to the log‐rank test (P = 0.015). According to Cox multivariate analysis, ALDH1 expression in carcinoma cells was an independent prognostic indicator of RFS (P = 0.025). The log‐rank test revealed that stromal expression of ALDH1 had no effect on RFS. Conclusions: ALDH1 expression in carcinoma cells is an independent prognostic factor in TN breast cancer patients.     

High tumor-infiltrating macrophage density predicts poor prognosis in patients with primary hepatocellular carcinoma after resection

Macrophages constitute a major component of the leukocyte infiltrate of tumors and perform distinct roles in different tumor microenvironments. This study attempted to investigate the prognostic values of tumor-infiltrating macrophages in patients with hepatocellular carcinoma after resection, paying particular attention to their tissue microlocalization. The CD68(+) macrophages were assessed by immunohistochemistry in tissues from 137 patients with hepatocellular carcinoma. Prognostic value of intratumoral, marginal, and peritumoral macrophage densities was evaluated by Kaplan-Meier analysis and Cox regression. Both intratumoral and marginal macrophage densities were associated inversely with overall survival (P = .034 and .004, respectively) and disease-free survival (P = .006 and .008, respectively). In contrast, peritumoral macrophage density was associated with neither overall survival nor disease-free survival. Intratumoral macrophage density emerged as an independent prognosticator of overall survival (hazard ratio = 1.721, P = .049) and disease-free survival (hazard ratio = 2.165, P = .007). Marginal macrophage density, but not intratumoral macrophage density, was associated with vascular invasion, tumor multiplicity, and fibrous capsule formation. Our results demonstrate that high macrophage infiltration predicts poor prognosis in patients with hepatocellular carcinoma. These results, together with our previous report showing the distinct activation patterns of macrophages in different areas of tumor tissue, implies that macrophages in those areas may use different strategies to promote the tumor progression.     

Nuclear PKM2 expression predicts poor prognosis in patients with esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is one of the most common tumors worldwide, with a high malignant degree and poor prognosis. The present study aims to investigate the relationship between pyruvate kinase M2 (PKM2) expression and the prognosis of patients with ESCC. The expression of PKM2 in 86 cases of esophageal carcinoma tissues was tested using immunohistochemistry. The relationship between PKM2 expression and clinical pathological parameters, and their effects on the prognosis of patients with ESCC were analyzed. The expression levels of PKM2 in both cytoplasm and nucleus of ESCC tissues were significantly higher than those in paracancerous tissues (P = 6.73 × 10⁻⁹ and 4.32 × 10⁻⁶, respectively). The Kaplan–Meier analysis showed that nuclear PKM2 expression was closely related to the survival of patients with ESCC (P = 0.005). Patients with high PKM2 expression in the nucleus had significantly shorter survival times than those with low PKM2 expression in the nucleus (hazard ratio for death, 2.358; 95% confidence interval, 1.156–4.812; P = 0.018). No other significant difference was found between PMK2 expression and clinico-pathological features of ESCC patients (all P > 0.05). In conclusion, high PKM2 expression in the nucleus is essential in the pathogenic process of ESCC and may be used to predict the prognosis of patients with ESCC.     

Increased expression of Rab5A predicts metastasis and poor prognosis in colorectal cancer patients

Rab5A is reported to correlate with cancer development and progression. The purpose of this study is to explore the association between Rab5A expression and the clinical characteristics of colorectal cancer (CRC). Data containing three independent investigations from Oncomine database demonstrated that Rab5A is overexpression in CRC compared with normal tissue, similar result was also found in 32 matched CRC tissue samples by qPCR. The protein expression of Rab5A was examined in 390 CRC specimens and the results showed that high expression of Rab5A was significantly correlated with tumor size (P = 0.008), serum CEA (P = 0.002), liver metastasis (P = 0.014) and clinical stage (P = 0.010). Kaplan-Meier method suggested that overexpression of Rab5A protein expression had shorter overall survival times in CRC patients (P < 0.001). Multivariate Cox regression analysis confirmed Rab5A expression, tumor size and clinical stage as independent prognostic factor in CRC. In conclusion, the data indicated that higher expression of Rab5A was observed in CRC tissues and Rab5A may be identified as a useful predictor of metastasis and prognosis for CRC.     

Increased expression of hepatoma-derived growth factor correlates with poor prognosis in human nasopharyngeal carcinoma

Wang S & Fang W
(2011) Histopathology 58 , 217–224
Increased expression of hepatoma‐derived growth factor correlates with poor prognosis in human nasopharyngeal carcinoma Aims: To examine the correlation between hepatoma‐derived growth factor (HDGF) expression and clinicopathological data in nasopharyngeal carcinoma (NPC), including patient survival. Methods and results: Using real‐time polymerase chain reaction (PCR) and Western blot, mRNA and protein expression of HDGF was detected in normal nasopharyngeal tissues, NPC tissues and cell lines. HDGF levels were determined further by an immunohistochemical analysis in a retrospective series consisting of 160 primary NPC tissues and 71 non‐cancerous nasopharynx tissues. Overexpressed mRNA and HDGF protein was present in NPC. By immunohistochemical analysis, we found that 53.8% (86 of 160) and 19.4% (32 of 160) of NPC biopsy specimens showed higher HDGF expression of the nucleus and cytoplasm, respectively. Statistical analysis showed that the higher expression of nuclear HDGF was associated significantly with T stage (P = 0.005) and clinical stage (P = 0.038), but there was no association with lymph node (P = 0.059) or distant metastasis (P = 0.563). Patients with increased HDGF expression levels had poorer overall survival rates than those with low expression of HDGF levels (P = 0.006). Multivariate analysis revealed that high expression of nuclear HDGF was an independent prognostic indicator of patient survival. Conclusions: Increased nuclear expression of HDGF is a potential unfavourable prognostic factor for patients with NPC.     

乳腺癌中Syk、VEGF-C表达与淋巴结转移的关系

目的研究乳腺癌组织中Syk、VEGF-C的表达与淋巴结转移的关系。方法分别采用免疫组织化学EnVision两步法及SP法检测55例乳腺癌组织中Syk、NFκB(p65)及VEGF-C的表达情况。结果55例乳腺癌组织中,Syk、VEGF-C及p65阳性率分别为50.9%,56.4%,81.8%。Syk在淋巴结转移组的表达低于无淋巴结转移组(P0.05);VEGF-C在淋巴结转移组的表达高于无淋巴结转移组(P0.05);p65在两组之间的表达差异无显著性(P0.75),p65胞核移位率在淋巴结转移组高于无淋巴结转移组(P0.025)。随着Syk表达增强VEGF-C的表达减弱,二者呈负相关(r=-0.620,P=0.000);p65胞核移位与Syk的表达强度降低有关(r=0.448,P=0.002),而与VEGF-C的表达强度增高有关(r=0.310,P=0.036)。结论乳腺癌中,Syk可能通过抑制NFκB的活性而下调VEGF-C的表达,从而抑制乳腺癌的淋巴结转移。     

Increased expression of microRNA-196a predicts poor prognosis in human ovarian carcinoma

Objective: Overexpression of MicroRNA-196a (miR-196a) has recently been reported in different types of human cancers. However, the prognostic value of miR-196a in ovarian carcinoma remains unknown. In this study, we investigated the expression of miR-196a in ovarian carcinoma and its relationship with tumor progression and clinical prognosis. Methods: The expression level of miR-196a was examined by quantitative Real-time PCR (qRT-PCR) in surgically removed ovarian cancer tissues and ovarian cancer cell lines. The correlation between miR-196a expression and clinical features and prognosis were statistically analyzed. Results: The results showed that the miR-196a expression was significantly upregulated in tumor tissues and ovarian cancer cell lines compared with that in normal ovarian surface tissues and normal ovarian epithelial cells. Moreover, miR-196a expression was positively correlated with FIGO stage (P <0.001), tumor size (P =0.020), and lymph nodes metastasis (P =0.019). Kaplan-Meier analysis demonstrated that high levels of miR-196a expression was associated with poorer overall survival (P <0.001) and recurrent-free survival (P =0.003), especially in patients with advanced disease (P =0.002). Multivariate analysis suggested that miR-196a expression was an independent prognostic factor for overall survival of patients with ovarian carcinoma. Conclusions: In conclusion, miR-196a may play an important role in the progression of ovarian carcinoma, and could be used as an independent prognostic biomarker for patients with ovarian carcinoma.