Tumor angiogenesis in predicting the survival of patients with stage I lung cancer

Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis

BACKGROUND

The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT).

METHODS

A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates.

RESULTS

A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses.

CONCLUSION

Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.

Nickel-induced VEGF expression via regulation of Akt, ERK1/2, NFκB, and AMPK pathways in H460 cells

Prospective cohort studies have indicated that a highly nickel-polluted environment may severely affect human health, resulting in such conditions as respiratory tract cancers. Such exposure can trigger vascular endothelial growth factor (VEGF) expression. However, the signal transduction pathways leading to VEGF induction by nickel compounds are not well understood. This study revealed the occurrence of VEGF induction in human non-small-cell lung cancer H460 cells exposed to NiCl₂ . Moreover, exposing H460 cells to NiCl₂ activated extracellular signal-regulated protein kinase (ERK), nuclear factor kappa B (NFκB), and protein kinase B (Akt) as well as downregulated AMP activated protein kinase (AMPK) expression. The mitogen-activated protein kinase (MAPK) and ERK inhibitor significantly blocked NiCl₂ -induced ERK activation and VEGF production. Pretreating H460 cells with a PI3K/Akt inhibitor substantially inhibited NiCl₂ -induced VEGF expression and reduced Akt, ERK, and NFκB phosphorylation. Furthermore, 5-aminoimidazole-4-carboxamide ribonucleoside-induced AMPK activation improved VEGF expression in NiCl₂ -treated H460 cells significantly. These results indicate that NiCl₂ induces VEGF production through Akt, ERK, NFκB activation and AMPK suppression and mediates various types of pathophysiological angiogenesis.

Effects of ephrinB2 gene siRNA on the biological behavior of human colorectal cancer cells

Colorectal cancer (CRC) is a common gastrointestinal malignancy worldwide and is a lethal and aggressive malignancy with a dismal prognosis. EphrinB2 is a membrane-bound ligand and has an intracellular domain that also possesses an intrinsic signaling capacity called 'reverse signaling'. In the present study, CRC cell lines were screened for high expression of ephrinB2. Small interfering RNA (siRNA) knockdown of ephrinB2 was performed in human SW480 CRC cells. The levels of expression of ephrinB2, VEGF, CD105 and matrix metalloproteinase 9 (MMP9) protein were measured by western blotting, and messenger RNA (mRNA) levels were measured using real-time PCR. Apoptosis and cell cycle distribution were determined using flow cytometry. Cell proliferation was measured by a methyl thiazole tetrazolium (MTT) test and a scratch healing experiment was used to measure the extent of cell migration. A Transwell assay was used to detect the extent of cell invasion. The results showed that RNA interference (RNAi) of ephrinB2 effectively silenced the ephrinB2 gene at both the mRNA and protein levels in SW480 cells and inhibited the proliferation, invasion, migration and angiogenesis and induced apoptosis in SW480 cells. These effects may be attributed to VEGF and MMP9 regulation.

Contrast enhanced computed tomography is indicative for angiogenesis pattern and display prognostic significance in breast cancer

Background

The Prognostic value of microvessel density in cancer remains unclear. Recent studies have suggested that the uneven distribution of microvessels in tumours caused the variation in sample selection which led to different prognostic outcome. The enhancement pattern of Contrast-enhanced computed tomography (CECT) is determined in part by the microvessel distribution in solid tumors. Therefore, survival analysis of tumors grouping by the enhancement pattern and the pattern of microvessel distribution is important.

Methods

Survival analysis grouped by the tumor enhancement pattern and the microvessel distribution was carried out in 255 patients with invasive ductal carcinoma.

Results

There were significant differences in overall survival (OS) and disease-free survival (DFS) among the homogeneous, heterogeneous and peripheral enhancement groups. There were significant differences between OS and DFS groups with uniform and uneven distributions of microvessels.

Conclusions

The distribution of microvessels in a tumor is a potential prognostic indicator in patients with breast cancer, and can be assessed by CECT prior the operation.

Prognostic significance of Ki67 proliferation index, HIF1 alpha index and microvascular density in patients with non-small cell lung cancer brain metastases

BACKGROUND

Survival upon diagnosis of brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) is highly variable and established prognostic scores do not include tissue-based parameters.

METHODS

Patients who underwent neurosurgical resection as first-line therapy for newly diagnosed NSCLC BM were included. Microvascular density (MVD), Ki67 tumor cell proliferation index and hypoxia-inducible factor 1 alpha (HIF-1 alpha) index were determined by immunohistochemistry.

RESULTS

NSCLC BM specimens from 230 patients (151 male, 79 female; median age 56 years; 199 nonsquamous histology) and 53/230 (23.0%) matched primary tumor samples were available. Adjuvant whole-brain radiation therapy (WBRT) was given to 153/230 (66.5%) patients after neurosurgical resection. MVD and HIF-1 alpha indices were significantly higher in BM than in matched primary tumors. In patients treated with adjuvant WBRT, low BM HIF-1 alpha expression was associated with favorable overall survival (OS), while among patients not treated with adjuvant WBRT, BM HIF-1 alpha expression did not correlate with OS. Low diagnosis-specific graded prognostic assessment score (DS-GPA), low Ki67 index, high MVD, low HIF-1 alpha index and administration of adjuvant WBRT were independently associated with favorable OS. Incorporation of tissue-based parameters into the commonly used DS-GPA allowed refined discrimination of prognostic subgroups.

CONCLUSION

Ki67 index, MVD and HIF-1 alpha index have promising prognostic value in BM and should be validated in further studies.

CD105/Ki67 coexpression correlates with tumor progression and poor prognosis in epithelial ovarian cancer

AIM

To analyze the expression patterns of CD105 and Ki67 in human epithelial ovarian cancer (EOC) and to evaluate the clinical significance of these two markers in the progression and prognosis in EOC.

MATERIALS AND METHODS

The CD105 and Ki67 protein expression patterns in paraffin-embedded specimens gathered from 166 patients with EOC were detected by immunohistochemistry analysis. The association of CD105 and Ki67 protein expression with the prognosis in EOC was subsequently assessed.

RESULTS

The CD105 and Ki67 proteins were positively expressed in 101/166 (60.8%) and 129/166 (77.7%) of EOC patients, respectively. The CD105 tumors are more likely to have higher tumor grade (P = 0.02). Patients with positive Ki67 staining are more likely to be at the advanced stage of the disease (P = 0.008). Marker CD105 was positively correlated with Ki67 (r = 0.66, P = 0.01). In addition, Ki67 (hazards ratio [HR], 4.8; confidence interval [CI], 1.2-16.6; P = 0.008) and CD105⁺ (HR, 4.1; CI, 1.0-15.2; P = 0.01) were both independent prognostic factors for poor overall survival in EOC patients. Furthermore, combined CD105/Ki67 expression was significantly related to unfavorable overall survival (HR, 16.6; CI, 1.2-128.9; P < 0.001).

CONCLUSIONS

Our results suggest that the CD105 and Ki67 expressions might be involved in the progression of EOC and patient prognosis. A combined detection of CD105/Ki67 coexpression may benefit us in predicting the prognosis in EOC.

Number of circulating endothelial progenitor cells and intratumoral microvessel density in non-small cell lung cancer patients: differences in angiogenic status between adenocarcinoma histologic subtypes

INTRODUCTION

Angiogenesis plays a significant role in tumor progression. This study examined the association between the number of circulating endothelial progenitor cells (EPCs), intratumoral microvessel density (MVD) (both of which may be markers for neovascularization), and lung cancer histological types, particularly adenocarcinoma histological subtypes.

METHODS

A total of 83 stage I non-small cell lung cancer (NSCLC) patients underwent complete tumor resection between November 2009 and July 2010. The number of EPCs from the pulmonary artery of the resected lungs was measured by assaying CD34/vascular endothelial growth factor receptor 2 positive cells, and the MVD was assessed immunohistochemically in tumor specimens by staining for CD34.

RESULTS

A statistically significant correlation between the number of EPCs from pulmonary artery and intratumoral MVD was found (p < 0.001). No statistically significant differences in the number of EPCs and the MVD were observed between the adenocarcinomas and the squamous cell carcinomas. Among the adenocarcinoma histological subtypes, a higher number of EPCs and MVD were found significantly more frequently in solid adenocarcinomas than in nonsolid adenocarcinomas (p < 0.001 and p = 0.011, respectively). In addition, solid adenocarcinomas showed higher levels of vascular endothelial growth factor using quantitative real-time polymerase chain reaction in the tumor tissue samples than in the nonsolid adenocarcinomas (p = 0.005).

CONCLUSION

The higher number of circulating EPCs and the MVD of solid adenocarcinoma may indicate the presence of differences in the tumor angiogenic status between early-stage adenocarcinoma histological subtypes. Among adenocarcinoma patients, patients with solid adenocarcinoma may be the best candidates for antiangiogenic therapies.

HGF Airway Over-expression Leads to Enhanced Pulmonary Vascularization without Induction of VEGF

The hepatocyte growth factor (HGF)/c-Met signaling pathway mediates angiogenesis. We have previously reported that airway expression of a human HGF transgene (HGF TG) produced mice that were more susceptible to lung tumorigenesis induced by 4-(methylnitrosoamino)-1-(3-pyridyl)-1-butanone (NNK). Here we show untreated HGF TG mice display enhanced vascularization (40 wks) and enhanced lymph vessel formation (20 wks) in the lungs compared to wild-type (WT) littermates, as ascertained by microvessel density. We profiled mRNA expression from HGF TG and WT mice for genes involved in angiogenesis. We consistently found significant decreases in expression of the VEGF family of angiogenic genes, including Vegfa, Vegfb, Vegfc, and Vegfd / Figf. Decreases were confirmed in whole lung protein extracts by immunoblot. Similar patterns of down-regulation were observed at 10, 20, and 40 wks of age. Vandetanib, an inhibitor of VEGFR2 and VEGFR3, did not prevent the increase in microvessel density observed in HGF TG mice. Reduction in VEGF pathway genes was also detected in lung tumors derived from NNK-treated HGF TG mice. HGF TG lung tumors also showed increased expression of five Cxcl family genes including Cxcl1 and Cxcl2 (murine forms of IL8). These results suggest increased vascularization produced by airway over-expression of HGF occurs through direct activation of c-Met on endothelial cells, rather than induction of VEGF pathways. Elevated HGF may also increase expression of inflammatory mediators that contribute to lung tumor progression.