Nuclear survivin expression is associated with a poor prognosis in Caucasian non-small cell lung cancer patients

The prognostic significance of tumor budding and the expression of focal adhesion kinase and survivin in lung adenocarcinoma

OBJECTIVES

Adenocarcinoma is the tumor group with the highest incidence among lung cancers with poor prognosis. Tumor budding (TB) is the migration of single tumor cells or small clusters of cells from the neoplastic epithelium to the invasive front of the tumor. Focal adhesion kinase (FAK) and survivin are considered as poor prognostic factors in several tumors. Hence, we investigated TB, FAK, and survivin expression in lung adenocarcinoma.

METHODS

The study included 103 cases of lung adenocarcinoma in the resection materials. In tumoral tissues; TB was counted and scored in one high-power field (HPF), as low if <5 in 1 HPF and high if ≥5 in 1 HPF. FAK and survivin were studied immunohistochemically.

RESULTS

The mean number of TB in 1 HPF is 3.96 ± 2.8. Low-grade TB was observed in 45 (43.7 %) and high-grade TB was observed in 58 (56.3 %) patients. There was a positive correlation between TB and pT stage (p = 0.017), clinical stage (p = 0.002), lymphovascular invasion (p = 0.001), and perineural invasion (p = 0.045). The 4-year survival rate in patients was 90 % in those with low-grade TB and 60 % in those with high-grade TB (p = 0.001). FAK and survivin expressions were significantly increased in tumors with high-grade TB (p < 0.05).

CONCLUSION

A significant correlation was found between the grade of TB and pT stage, clinical stage, lymphovascular and perineural invasion in lung adenocarcinoma. TB can be considered as a histological parameter showing poor prognosis. It is thought that high expression of FAK and survivin also affect the prognosis in these patients by increasing TB.

Differential Gene Expression in Erlotinib-Treated Fibroblasts

BACKGROUND

Therapies targeting the epidermal growth factor receptor (EGFR) result in a painful rash, the most common and debilitating toxicity among patients with non-small cell lung cancer (NSCLC) who take EGFR tyrosine kinase inhibitor (TKI) therapy; however, predicting the development and the severity of the rash is difficult.

OBJECTIVE

The aim of this study was to examine how erlotinib-an EGFR TKI that NSCLC patients take to stop or slow tumor growth-altered the transcriptome of dermal fibroblasts.

METHODS

Dermal fibroblasts (ATCC PCS-201-012) were seeded in cell culture flasks, grown under standard conditions, and transferred to cell culture dishes. Cells were treated once daily for 3 days with erlotinib 100 nM (n = 5), erlotinib 1 μM (n = 5), vehicle 1 μM (dimethyl sulfoxide) (n = 5), or no treatment (n = 5). Total RNA was extracted using a standard TRIzol method and hybridized using Affymetrix GeneChip Human Genome U133 Plus 2.0 arrays. Raw intensities generated from the arrays were normalized using a Robust Multiarray Average method and analyzed using analysis of variance in Limma R software. Differentially expressed genes were analyzed using Ingenuity Pathway Analysis to identify canonical or noncanonical signaling pathways enriched in this dataset.

RESULTS

We selected genes for investigation based on their potential role in wound healing (AQP3), rash development (CCL2), fibroblast activation (PALLD), cancer and cancer progression (GDF-15, SLC7A11, MMP12, and DIRAS3), and cell cycle control (CDC6). We were able to validate four of these genes by both Western blot analysis and quantitative polymerase chain reaction (MMP12, CCL2, CDC6, and SLC7A11).

DISCUSSION

If found predictive of rash in future studies using patient samples, our findings may help to identify those at risk for severe rash so that (a) the dose of EGFR TKI therapy may be adjusted; (b) additional treatments for the rash can be developed; and/or (c) precise, patient-centered interventions can be developed so that patients with cancer can better self-manage their rash and adhere to EGFR TKI treatment.

PD-L1 over-expression is associated with a poor prognosis in Asian non-small cell lung cancer patients

BACKGROUND

The prognostic role of programmed cell death-ligand 1 (PD-L1) in non-small cell lung cancer (NSCLC) remains controversial. This meta-analysis was conducted to clarify the association of PD-L1 with survival in NSCLC patients.

METHODS

Relevant studies were collected from PubMed, Embase and Web of Science. Only studies in which PD-L1 expression was detected by immunohistochemical staining in NSCLC patients correlated with patient survival data were included. Stata 12.0 was performed in this meta-analysis.

RESULTS

Fifteen studies with 3116 patients were included in this meta-analysis. The combined hazard ratio (HR) of 1.18 (95%CI, 0.90-1.56; P>0.05) shows that PD-L1 over-expression in NSCLC patients didn't associate with overall survival (OS). However, subgroup analysis indicated that PD-L1 over-expression was correlated with poor OS in Asian patients (HR=1.84, 95%CI: 1.14-2.28; P<0.001). Moreover, the results suggested that a significant relationship between PD-L1 expression and OS was also showed in studies with late stage (HR=1.27, 95%CI: 1.06-1.48; P=0.031), poor tumor differentiation (HR=1.86, 95%CI: 1.35-2.64; P=0.001) and anaplastic lymphoma kinase (ALK) translocation (HR=2.58, 95%CI: 1.03-5.78; P=0.028).

CONCLUSIONS

PD-L1 over-expression is correlated with a poor prognosis in Asian NSCLC patients.

Overexpression of VEGF-C correlates with a poor prognosis in esophageal cancer patients

BACKGROUND

The prognostic value of vascular endothelial growth factor C (VEGF-C) in patients with esophageal cancer (EC) remains controversial. The aim of this meta-analysis was to clarify the association of VEGF-C with survival in EC patients.

METHODS

We performed a meta-analysis that included eligible studies to expound the effect of VEGF-C in EC survival. Eligible studies published until November 2015 was identified using available databases. STATA 12.0 was performed in this meta-analysis.

RESULTS

We identified 13 studies, including 1203 patients, in this meta-analysis. The combined hazard ratio of 1.70 (95% CI, 1.43-2.03, P < 0.001) shows that VEGF-C overexpression was significantly correlated with poor overall survival in EC patients. Furthermore, the results suggested a significant relationship between VEGF-C expression and overall survival was also showed in studies with patient source, patient number ≥ 70, methods detecting VEGF-C by reverse transcription PCR (RT-PCR) or ELISA and histology type. Moreover, combined odds ratio of VEGF-C displayed that VEGF-C overexpression was significantly association with stage, depth of tumor invasion, lymph node status and metastasis of EC (P < 0.05). However, it has no correlation with differentiation degree of EC (P > 0.05).

CONCLUSION

VEGF-C overexpression shows an unfavorable prognosis for EC patients.

Survivin expression in lung cancer: Association with smoking, histological types and pathological stages

Survivin is expressed in the nucleus and/or cytoplasm of various malignant cells. Nuclear survivin is critical for the completion of mitosis, while cytoplasmic survivin functions as an inhibitor of apoptosis. The expression of survivin has been reported to be associated with the aggressiveness of certain types of cancer. The present study examined the association between cigarette smoking history and the expression of survivin and Ki-67 in lung adenocarcinomas of pathological (p) stages I, II and III. The expression of survivin and Ki-67 in adenocarcinomas was also compared with that of other p-stage I lung cancers, including squamous cell carcinoma (SqCC), large cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SmCCs), of patients with a smoking history. In adenocarcinomas at p-stage I, labeling indices (LIs) of nuclear survivin and Ki-67 were significantly higher in tissue samples from smokers than those from non-smokers; however, the nuclear survivin and Ki-67 LIs in p-stage II and III adenocarcinomas from non-smokers and smokers were similar to those in p-stage I adenocarcinomas of smokers. The nuclear survivin and Ki-67 LIs in adenocarcinomas of smokers at p-stage I were lower than those in SqCCs, LCNECs and SmCCs of smokers at the same stage. Smokers with adenocarcinoma also exhibited a higher survival rate compared with that of smokers with SqCCs, LCNECs and SmCCs. The present results indicated that a history of smoking is associated with increased nuclear survivin and Ki-67 expression in lung adenocarcinomas of p-stage I, but not p-stages II or III. In addition it was revealed that, in smokers, the nuclear survivin and Ki-67 expression in p-stage I adenocarcinomas was lower than that of other p-stage I lung cancer types, and was associated with an enhanced survival rate. In conclusion, smoking is associated with the histogenesis of lung adenocarcinoma but not with the development of lung adenocarcinoma, based on the nuclear expression levels of Ki-67 and survivin.

Survivin over-expression is correlated with a poor prognosis in esophageal cancer patients

BACKGROUND

The prognostic role of survivin in esophageal cancer (EC) remains controversial. This meta-analysis aimed to clarify the association of survivin with survival in EC patients.

METHODS

Relevant studies published up to November 2014 were identified using PubMed and Embase. Only studies in which survivin was detected through immunohistochemical staining were included. STATA 12.0 was used in this meta-analysis.

RESULTS

A total of 9 studies, which comprised 610 patients, were included in the meta-analysis. The combined hazard ratio (HR) of 1.76 (95% CI, 1.40-2.21; P<0.001) suggests that survivin overexpression in EC patients was significantly associated with poor overall survival. Moreover, the results showed a significant relationship between overall survival and survivin expression was also displayed in studies with a non-Asian country (HR, 1.75; 95% CI, 1.30-2.35), patient number ≥ 50 (HR, 1.86; 95% CI, 1.57-2.20), the cut-off level ≥ 5% (HR, 1.43; 95% CI, 0.94-2.17) and the esophageal squamous cell carcinoma (HR, 1.82; 95% CI, 1.43-2.30). However, combined odds ratio of survivin indicated that survivin overexpression has no correlation with stage, grade of differentiation, lymph node status, depth of invasion and distant metastasis of EC (P>0.05).

CONCLUSION

Survivin overexpression is associated with poor prognosis in EC patients.

BRCA1-IRIS inactivation overcomes paclitaxel resistance in triple negative breast cancers

Introduction

Intrinsic or acquired chemoresistance is a major problem in oncology. Although highly responsive to chemotherapies such as paclitaxel, most triple negative breast cancer (TNBC) patients develop chemoresistance. Here we investigate the role of BRCA1-IRIS as a novel treatment target for TNBCs and their paclitaxel-resistant recurrences.

Methods

We analyzed the response of BRCA1-IRIS overexpressing normal mammary cells or established TNBC cells silenced from BRCA1-IRIS to paclitaxel in vitro and in vivo. We analyzed BRCA1-IRIS downstream signaling pathways in relation to paclitaxel treatment. We also analyzed a large cohort of breast tumor samples for BRCA1-IRIS, Forkhead box class O3a (FOXO3a) and survivin expression. Finally, we analyzed the effect of BRCA1-IRIS silencing or inactivation on TNBCs formation, maintenance and response to paclitaxel in an orthotopic model.

Results

We show that low concentrations of paclitaxel triggers BRCA1-IRIS expression in vitro and in vivo, and that BRCA1-IRIS activates two autocrine signaling loops (epidermal growth factor (EGF)/EGF receptor 1 (EGFR)-EGF receptor 2 (ErbB2) and neurogulin 1 (NRG1)/ErbB2-EGF receptor 3 (ErbB3), which enhances protein kinase B (AKT) and thus survivin expression/activation through promoting FOXO3a degradation. This signaling pathway is intact in TNBCs endogenously overexpressing BRCA1-IRIS. These events trigger the intrinsic and acquired paclitaxel resistance phenotype known for BRCA1-IRIS-overexpressing TNBCs. Inactivating BRCA1-IRIS signaling using a novel inhibitory mimetic peptide inactivates these autocrine loops, AKT and survivin activity/expression, in part by restoring FOXO3a expression, and sensitizes TNBC cells to low paclitaxel concentrations in vitro and in vivo. Finally, we show BRCA1-IRIS and survivin overexpression is correlated with lack of FOXO3a expression in a large cohort of primary tumor samples, and that BRCA1-IRIS overexpression-induced signature is associated with decreased disease free survival in heavily treated estrogen receptor alpha-negative patients.

Conclusions

In addition to driving TNBC tumor formation, BRCA1-IRIS overexpression drives their intrinsic and acquired paclitaxel resistance, partly by activating autocrine signaling loops EGF/EGFR-ErbB2 and NRG1/ErbB2-ErbB3. These loops activate AKT, causing FOXO3a degradation and survivin overexpression. Taken together, this underscores the need for BRCA1-IRIS-specific therapy and strongly suggests that BRCA1-IRIS and/or signaling loops activated by it could be rational therapeutic targets for advanced TNBCs.

Survivin beyond physiology: orchestration of multistep carcinogenesis and therapeutic potentials

Survivin, a member of the inhibitor of apoptosis protein family, has been associated with protection from cell apoptosis and regulation of mitosis. Survivin exhibits low to undetectable expression in most finally differentiated adult tissues but is abundantly over-expressed in almost all cancers. The aberrant high expression of survivin in cancers is associated with advanced disease, increased rate of tumor recurrence, abbreviated overall survival and resistance to chemo- and radio- therapy. Survivin touches nearly every aspect of cancer and is involved in the initiation, maintenance and development of tumor. Therefore, its significance in cancer dictates the pursuit for anti-survivin cancer therapies.

Arctigenin enhances chemosensitivity to cisplatin in human nonsmall lung cancer H460 cells through downregulation of survivin expression

Arctigenin, a dibenzylbutyrolactone lignan, enhances cisplatin-mediated cell apoptosis in cancer cells. Here, we sought to investigate the effects of arctigenin on cisplatin-treated non-small-cell lung cancer (NSCLC) H460 cells. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and annexin-V/propidium iodide staining were performed to analyze the proliferation and apoptosis of H460 cells. Arctigenin dose-dependently suppressed cell proliferation and potentiated cell apoptosis, coupled with increased cleavage of caspase-3 and poly(ADP-ribose) polymerase. Moreover, arctigenin sensitized H460 cells to cisplatin-induced proliferation inhibition and apoptosis. Arctigenin alone or in combination with cisplatin had a significantly lower amount of survivin. Ectopic expression of survivin decreased cell apoptosis induced by arctigenin (P < 0.05) or in combination with cisplatin (P < 0.01). Moreover, arctigenin (P < 0.05) or in combination with cisplatin (P < 0.01) induced G1/G0 cell-cycle arrest. Our data provide evidence that arctigenin has a therapeutic potential in combina-tion with chemotherapeutic agents for NSLC.