Decreased expression of focal adhesion kinase is associated with a poor prognosis in extrahepatic bile duct carcinoma

The Role of ECM Remodeling, EMT, and Adhesion Molecules in Cancerous Neural Invasion: Changing Perspectives

Perineural invasion (PNI) refers to the cancerous invasion of nerves. It provides an alternative route for metastatic invasion and can exist independently in the absence of lymphatic or vascular invasion. It is a prominent characteristic of specific aggressive malignancies where it correlates with poor prognosis. The clinical significance of PNI is widely recognized despite a lack of understanding of the molecular mechanisms underlying its pathogenesis. The interaction between the nerve and the cancer cells is the most pivotal PNI step which is mediated by the activation or inhibition of multiple signaling pathways that include chemokines, interleukins, nerve growth factors, and matrix metalloproteinases, to name a few. The nerve-cancer cell interaction brings about specific changes in the perineural niche, which not only affects the regular nerve functions, but also enhances the migratory, invasive, and adherent properties of the tumor cells. This review aims to elucidate the vital role of adhesion molecules, extracellular matrix, and epithelial-mesenchymal proteins that promote PNI, which may serve as therapeutic targets in the future.

Association of Low Tumor Endothelial Cell pY397-Focal Adhesion Kinase Expression With Survival in Patients With Neoadjuvant-Treated Locally Advanced Breast Cancer

IMPORTANCE

Determining the risk of relapse after neoadjuvant chemotherapy in patients with locally advanced breast cancer is required to offer alternative therapeutic strategies.

OBJECTIVE

To examine whether endothelial cell phosphorylated-focal adhesion kinase (EC-pY397-FAK) expression in patients with treatment-naive locally advanced breast cancer is a biomarker for chemotherapy sensitivity and is associated with survival after neoadjuvant chemotherapy.

DESIGN, SETTING, AND PARTICIPANTS

In this prognostic study, expression levels of EC-pY397-FAK and tumor cell (TC)-pY397-FAK were determined by immunohistochemistry in prechemotherapy core biopsies from 82 female patients with locally advanced breast cancer treated with anthracycline-based combination neoadjuvant chemotherapy at Nottingham City Hospital in Nottingham, UK. Median follow-up time was 67 months. The study was conducted from December 1, 2010, to September 28, 2019, and data analysis was performed from October 2, 2019, to March 31, 2020.

EXPOSURES

All women underwent surgery followed by adjuvant radiotherapy and, if tumors were estrogen receptor-positive, 5-year tamoxifen treatment.

MAIN OUTCOMES AND MEASURES

Outcomes were pathologic complete response and 5-year relapse-free survival examined using Kaplan-Meier, univariable logistic, multivariable logistic, and Cox proportional hazards models.

RESULTS

A total of 82 women (age, 29-76 years) with locally advanced breast cancer (stage IIA-IIIC) were included. Of these, 21 women (26%) had high EC-pY397-FAK expression that was associated with estrogen receptor positivity (71% vs 46%; P = .04), progesterone receptor positivity (67% vs 39%; P = .03), high Ki67 (86% vs 41%; P < .001), 4-immunohistochemically stained luminal-B (52% vs 8%; P < .001), higher tumor category (T3/T4 category: 90% vs 59%; P = .01), high lymph node category (N2-3 category: 43% vs 5%; P < .001), and high tumor node metastasis stage (IIIA-IIIC: 90% vs 66%; P = .03). Of 21 patients with high EC-pY397-FAK expression levels, none showed pathologic complete response, compared with 11 of 61 patients with low EC-pY397-FAK expression levels who showed pathologic complete response (odds ratio, 0.70; 95% CI, 0.61-0.82; P = .04). High EC-pY397-FAK expression levels and high blood vessel density (BVD) were associated with shorter 5-year relapse-free survival compared with those with low EC-pY397-FAK expression levels (hazard ratio [HR], 2.21; 95% CI, 1.17-4.20; P = .01) and low BVD (HR, 2.2; 95% CI, 1.15-4.35; P = .02). High TC-pY397-FAK expression levels in 15 of 82 women (18%) were not associated significantly with pathologic complete response or 5-year relapse-free survival. A multivariable Cox regression model for 5-year relapse-free survival indicated that high EC-pY397-FAK expression levels was an independent poor prognostic factor after controlling for other validated prognostic factors (HR, 3.91; 95% CI, 1.42-10.74; P = .01). Combined analysis of EC-pY397-FAK expression levels, TC-pY397-FAK expression levels, and BVD improved prognostic significance over individually tested features.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that low EC-pY397-FAK expression levels are associated with chemotherapy sensitivity and improved 5-year relapse-free survival after systemic therapy. Combined analysis of high EC-pY397-FAK expression levels, high TC-pY397-FAK expression levels, and high BVD appeared to identify a high-risk population.

DIMT1 overexpression correlates with progression and prognosis in gastric carcinoma

We investigated the expression of dimethyladenosine transferase 1 homolog (DIMT1) in human gastric carcinoma (GC) tissues, pericarcinoma histologically normal tissues, and normal gastric tissues and explored its clinical significance. Immunohistochemistry staining was used to detect the expression of DIMT1, and the findings were compared with clinicopathological features of patients with GC. The result also was ascertained by Western blotting. The Kaplan-Meier method and log-rank test were used to compare the overall survival rate and time in the DIMT1 low-level and high-level expression groups. Immunohistochemical staining indicated that the expression of DIMT1 in GC tissues (65/75; 86.7%) was significantly more common (P<.001) than that in pericarcinoma histologically normal tissues (14/75; 18.7%) and normal gastric tissues (2/12; 16.7%). High expression of DIMT1 correlated closely with differentiation (P=.023), invasion (P=.042), lymph node metastasis (P=.008), distant metastasis (P=.006), and TNM stage (P=.013). Western blotting showed that DIMT1 expression correlated positively with TNM stage and implied that more advanced TNM stage was accompanied by higher expression of DIMT1 (P<.001). Kaplan-Meier survival analysis showed that high DIMT1 expression correlated significantly (P<.001) with a poor prognosis. Our data suggest that DIMT1 is a useful molecular biomarker to predict tumor progression and prognosis in patients with GC.

Prognostic Value of Focal Adhesion Kinase (FAK) in Human Solid Carcinomas: A Meta-Analysis

Background

Recently, the number of reports on focal adhesion kinase (FAK) as a vital therapeutic target in solid carcinomas has increased; however, the prognostic role of FAK status remains poorly understood. This study aims to evaluate the prognostic effect of FAK by means of a meta-analysis.

Methods

We performed a systematic literature search in order to examine the correlation between expression of FAK and overall survival(OS). The hazard ratio (HR) of OS was used to measure survival. A random-effects model was used to pool study statistics. Sensitivity and publication bias analyses were also conducted.

Results

Thirty eligible studies involving 4702 patients were included. The median expression rate of FAK was 54%. Meta-analysis of the HRs demonstrated that high FAK expression was associated with worse OS (average HR = 2.073, 95%confidence interval[CI]:1.712–2.510, p = 0.000). Regarding cancer type, FAK was associated with worse OS in gastric cancer (HR = 2.646,95% CI:1.743–4.017, p = 0.000), hepatocellular carcinoma (HR = 1.788,95% CI:1.228–2.602, p = 0.002), ovarian cancer (HR = 1.815, 95% CI: 1.193–2.762, p = 0.005), endometrial cancer (HR = 4.149, 95% CI:2.832–6.079, p = 0.000), gliomas (HR = 2.650, 95% CI: 1.205–5.829, p = 0.015), and squamous cell carcinoma (HR = 1,696, 95% CI: 1.030–2.793, p = 0.038). No association was found between HR and disease staging according to our meta-regression analysis.

Conclusions

Our study shows that high expression of FAK is associated with a worse OS in patients with carcinomas, but the association between FAK and prognosis varies according to cancer type. The value of FAK status in clinical prognosis in cancer needs further research.

Focal adhesion kinase: predictor of tumour response and risk factor for recurrence after neoadjuvant chemoradiation in rectal cancer

Rectal cancer represents about 30% of colorectal cancers, being around 50% locally advanced at presentation. Chemoradiation (CRT) followed by total mesorectal excision is the standard of care for these locally advanced stages. However, it is not free of adverse effects and toxicity and the complete pathologic response rate is between 10% and 30%. This makes it extremely important to define factors that can predict response to this therapy. Focal adhesion kinase (FAK) expression has been correlated with worse prognosis in several tumours and its possible involvement in cancer radio‐ and chemosensitivity has been suggested; however, its role in rectal cancer has not been analysed yet. To analyse the association of FAK expression with tumour response to CRT in locally advanced rectal cancer. This study includes 73 patients with locally advanced rectal cancer receiving standard neoadjuvant CRT followed by total mesorectal excision. Focal adhesion kinase protein levels were immunohistochemically analysed in the pre‐treatment biopsies of these patients and correlated with tumour response to CRT and patients survival. Low FAK expression was significantly correlated with local and distant recurrence (P = 0.013). Low FAK expression was found to be a predictive marker of tumour response to neoadjuvant therapy (P = 0.007) and patients whose tumours did not express FAK showed a strong association with lower disease‐free survival (P = 0.01). Focal adhesion kinase expression predicts neoadjuvant CRT response in rectal cancer patients and it is a clinically relevant risk factor for local and distant recurrence.

Focal adhesion protein expression in human diffuse large B-cell lymphoma

AIMS

Focal adhesions have been associated with poor prognosis in multiple cancer types, but their prognostic value in diffuse large B-cell lymphoma (DLBCL) has not been evaluated. The aim of this study was to investigate the expression patterns and the prognostic value of the focal adhesion proteins FAK, Pyk2, p130Cas and HEF1 in DLBCL.

METHODS AND RESULTS

Focal adhesion protein expression was examined using immunohistochemistry in normal lymphoid tissues and in 60 DLBCL patient samples. Kaplan-Meier survival and Cox regression analysis were performed to evaluate the correlation of focal adhesion protein expression with patient prognosis. FAK, Pyk2, p130Cas and HEF1 expression was mostly found in the germinal centres of normal human lymphoid tissues. When assessed in DLBCL samples, FAK, Pyk2, p130Cas and HEF1 were highly expressed in 45%, 34%, 42% and 45% of the samples, respectively. Multivariate Cox analysis revealed that decreased FAK expression was a significant independent predictor of poorer disease outcome.

CONCLUSIONS

FAK expression is an independent prognostic factor in DLBCL. Our results suggest that the addition of FAK immunostaining to the current immunohistochemical algorithms may facilitate risk stratification of DLBCL patients.

Involvement of focal adhesion kinase in cellular proliferation, apoptosis and prognosis of laryngeal squamous cell carcinoma

OBJECTIVE

This study aimed to investigate the relationship between focal adhesion kinase expression and clinicopathological factors, cell apoptosis and proliferation, and overall survival, in laryngeal squamous cell carcinoma.

METHODS

Immunohistochemical staining was used to detect the expression of focal adhesion kinase and proliferating cell nuclear antigen in tissue samples. Apoptotic cells were assessed using the terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labelling ('TUNEL') method.

RESULTS

The proportion of focal adhesion kinase expression was 73.26 per cent in tumour tissues, significantly greater than in normal tissues (p < 0.05), and was significantly related to laryngeal cancer clinical stage, lymph node metastasis and overall survival (p < 0.05). In the tumour cases assessed, up-regulation of focal adhesion kinase expression was significantly associated with decreased cell apoptosis and increased proliferation (p < 0.05).

CONCLUSION

These findings suggest that focal adhesion kinase may affect laryngeal squamous cell carcinoma progression through regulation of cell apoptosis and proliferation. Focal adhesion kinase expression is a major prognostic factor in laryngeal cancer patients.

Expression of focal adhesion kinase and phosphorylated focal adhesion kinase in human gliomas is associated with unfavorable overall survival

Human glioma is a malignancy that has no effective systemic therapy. Focal adhesion kinase (FAK) is overexpressed in various invasive and metastatic tumor cells. To investigate its prognostic value in human gliomas, which currently is unknown, we examined the expression patterns of FAK and its activated form, phospho-FAK (FAK pY397), and analyzed the correlation between their expression and prognosis in patients with gliomas. Immunohistochemical staining was performed to detect FAK and phospho-FAK expression patterns in the biopsies from 96 patients with primary gliomas. Kaplan-Meier survival and Cox regression analyses were performed to evaluate the prognosis of patients. As a result, the immunohistochemical analysis revealed that FAK and phospho-FAK both were associated significantly with the Karnofsky performance scale (KPS) score and World Health Organization (WHO) grades of patients with gliomas. Especially, the positive expression rates of FAK and phospho-FAK were significantly higher in patients with a higher grade (P = 0.01 and 0.02, respectively) and a lower KPS score (P = 0.006 and 0.008, respectively). The patients with FAK positive expression correlated with a poor prognosis of human gliomas (P = 0.006) as well as phospho-FAK (P = 0.01). The survival rate of the patients with FAK+/phospho-FAK+ expression was the lowest (P < 0.05), and conjoined expressions of FAK/phospho-FAK were an independent prognostic indicator of human gliomas (P < 0.05). In conclusion, the results suggest that the elevated expression of FAK and phospho-FAK is an important feature of human glioma. A combined detection of FAK/phospho-FAK coexpression may benefit us in the prediction of the prognosis of human glioma.