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Jiang T, Sun H, Li N, Jiang T. Metastasis pattern and prognosis of large cell neuroendocrine carcinoma: a population-based study. J Cancer Res Clin Oncol 2023; 149:13511-13521. [PMID: 37498395 PMCID: PMC10590330 DOI: 10.1007/s00432-023-04975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/04/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE As a rare type of tumor, the metastasis pattern of large cell neuroendocrine carcinoma (LCNEC) is still unclear. Our aim was to investigate metastatic patterns and develop a predictive model of prognosis in patients with advanced LCNEC. METHODS Patients of LCNEC diagnosed between 2010-2015 from the Surveillance, Epidemiology and End Results (SEER) database were retrospectively included. Chi-square test was used for baseline characteristics analysis. Survival differences were assessed using Kaplan-Meier curves. Independent prognostic factors identified by multivariate Cox proportional risk model were used for the construction of nomogram. RESULTS 557 eligible patients with metastasis LCNEC (median (IQR), 64 (56 to 72) years; 323 males) were included in this research. Among patients with isolated metastases, brain metastases had the highest incidence (29.4%), and multisite metastases had worse OS (HR: 2.020: 95% CI 1.413-2.888; P < 0.001) and LCSS (HR: 2.144, 95% CI 1.480-3.104; P < 0.001) in all age groups. Independent prognostic indicators including age, race, T stage, N stage, chemotherapy, radiotherapy and metastatic site were used for the construction of nomogram. Concordance index (C-index) and decision-curve analyses (DCAs) showed higher accuracy and net clinical benefit of nomogram compared to the 7th TNM staging system (OS: 0.692 vs 0.555; P < 0.001; LCSS: 0.693 vs 0.555; P < 0.001). CONCLUSIONS We firstly established a novel comprehensive nomogram to predict the prognosis of metastasis LCNEC. The prognostic model demonstrated excellent accuracy and predictive performance. Chemotherapy and metastasis pattern were the two strongest predictive variables. Close follow-up of patients with LCNEC is necessary to make individualized treatment decisions according to different metastasis patterns.
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Affiliation(s)
- Tongchao Jiang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Haishuang Sun
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China
- , Yinghua Dong Street, Hepingli, Chao Yang District, Beijing, 100029, China
| | - Na Li
- Division of Life Sciences and Medicine, Department of Neurosurgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, 81 Meishan Road, Shushan District, Hefei, 230000, Anhui, China
| | - Tongcui Jiang
- School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, Anhui, China.
- Biopharmaceutical Research Institute, Anhui Medical University, Hefei, 230032, Anhui, China.
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Bell PD, Huber AR, Agostini-Vulaj D. Clinicopathologic features of metastatic small cell carcinoma of the prostate to the liver: a series of four cases. Diagn Pathol 2021; 16:35. [PMID: 33892760 PMCID: PMC8067396 DOI: 10.1186/s13000-021-01096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/13/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Small cell neuroendocrine carcinoma of the prostate (SCNECP) is a rare, aggressive subtype of prostate carcinoma. Most SCNECP arise from conventional prostate adenocarcinoma (CPAC) treated with androgen deprivation therapy (ADT). CASE PRESENTATIONS We identified four cases of CPAC treated with ADT, which evolved to SCNECP with liver metastasis. The average interval between the diagnosis of CPAC and SCNECP was 102 months (range: 12 to 168). Histologically, the tumors showed nests of cells with high nuclear:cytoplasmic ratios, granular chromatin, and frequent mitoses. All cases were synaptophysin, chromogranin, and AE1/AE3 positive, with a Ki-67 labeling index ≥70%. NKX3.1 was negative in all but one case and TTF-1 was positive in half. Weak ERG positivity by IHC was seen in one case which also demonstrated the TMPRSS2-ERG gene rearrangement; all other cases were negative for ERG by IHC. Serum prostate specific antigen (PSA) levels were normal to near-normal in all. The median interval between the diagnosis of SCNECP and death was 3.25 months (range: 0.75 to 26). CONCLUSIONS Our case series highlights the importance of considering a prostate primary, even in the setting of normal PSA levels and loss of prostate markers, when diagnosing neuroendocrine carcinoma in the liver. Further, we emphasize the significance of diagnosing SCNECP that metastasizes to the liver, as it portends a particularly dismal prognosis.
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Affiliation(s)
- Phoenix D. Bell
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642 USA
| | - Aaron R. Huber
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642 USA
| | - Diana Agostini-Vulaj
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642 USA
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3
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Ploenes T, Aigner C. [Resection concepts for early stage neuroendocrine tumors of the lungs and bronchi]. Chirurg 2019; 89:440-447. [PMID: 29188355 DOI: 10.1007/s00104-017-0558-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neuroendocrine tumors of the lungs are a very inhomogeneous group of malignancies. The surgical treatment should be adapted to the anatomical localization and histological subtype and individualized according to the functional reserve. MATERIAL AND METHODS We performed a selective review of current literature, which was supplemented by personal experiences. RESULTS The currently available outcome data are very inhomogeneous and depend on the histological subtype of neuroendocrine pulmonary tumors. A radical R0 resection is the key for an improvement in long-term overall and disease-free survival. CONCLUSION Surgical treatment of carcinoid tumors is the current standard therapy. Sleeve resection should be performed, whenever possible. More aggressive tumors, such as large cell neuroendocrine carcinoma and small cell lung cancer should be treated in a multimodal concept.
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Affiliation(s)
- T Ploenes
- Abteilung für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen - Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Deutschland
| | - C Aigner
- Abteilung für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen - Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Deutschland.
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Hamilton G, Rath B, Ulsperger E. A review of the role of surgery for small cell lung cancer and the potential prognostic value of enumeration of circulating tumor cells. Eur J Surg Oncol 2016; 42:1296-302. [PMID: 27402116 DOI: 10.1016/j.ejso.2016.04.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/31/2016] [Accepted: 04/18/2016] [Indexed: 01/29/2023] Open
Abstract
Small cell lung cancer (SCLC) is disseminated in the majority of patients at first presentation and, thus, treated with chemoradiotherapy. Despite initial high response rates, chemoresistance appears rapidly and results in a dismal prognosis. However, patients with limited cancer may exhibit better disease control upon surgical treatment. Correct staging is highly critical in the selection of those patients which are likely to benefit from surgery. Studies of the inclusion of surgery in the multimodal treatment of SCLC vary widely in number of patients, selection, treatment and follow-up. Nevertheless surgical therapy for confined SCLCs achieves favorable long-term survival compared to chemoradiotherapy, depending on a precise assessment of the degree of tumor dissemination. Recently, extremely high counts of circulating tumor cells (CTCs) were reported in patients with SCLC compared to other malignancies. In several studies the number of CTCs was found to constitute a prognostic parameter and a marker of response to therapy. Therefore, the assessment of CTCs as so-called "Liquid Biopsy" seems to constitute a more precise method to detect tumor dissemination earlier when compared to clinical staging. In conclusion, in the era of precision oncology enumeration and identification of CTCs of SCLC patients have the potential to help in the selection of patients most suitable for tumor surgery.
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Affiliation(s)
- G Hamilton
- Department of Surgery, Medical University of Vienna, Vienna, Austria.
| | - B Rath
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - E Ulsperger
- Department of Internal Medicine, Hospital Horn, Horn, Austria
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5
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Cherubini E, Di Napoli A, Noto A, Osman GA, Esposito MC, Mariotta S, Sellitri R, Ruco L, Cardillo G, Ciliberto G, Mancini R, Ricci A. Genetic and Functional Analysis of Polymorphisms in the Human Dopamine Receptor and Transporter Genes in Small Cell Lung Cancer. J Cell Physiol 2016; 231:345-56. [PMID: 26081799 DOI: 10.1002/jcp.25079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/12/2015] [Indexed: 01/11/2023]
Abstract
The regulatory role of dopamine (DA) in endocrine, cardiovascular and renal functions has been extensively studied and used for clinical purposes. More recently DA has been indicated as a regulatory molecule for immune cells and malignant cell proliferation. We assessed the expression and the functional role DA, DA receptors, and transporters in primary small cell lung cancer (SCLC). By HPLC DA plasma levels were more elevated in SCLC patients in comparison with NSCLC patients and healthy controls. SCLC cell expressed DA D1- and D2-like receptors and membrane and vesicular transporters at protein and mRNA levels. We also investigated the effects of independent D1- or D2-like receptor stimulation on SCLC cell cultures. DA D1 receptor agonist SKF38393 induced the increase of cAMP levels and DARPP-32 protein expression without affecting SCLC growth rate. Cell treatment with the DA D1 receptor antagonist SCH23390 inhibited SKF38393 effects. In contrast, the DA D2 receptor agonist quinpirole (10 μM) counteracted, in a dose and time dependent way, SCLC cell proliferation, it did not affect cAMP levels and decreased phosphorylated AKT that was induced by DA D2 receptor antagonist sulpiride. However, in only one SCLC line, stimulation of DA D2 receptor failed to inhibit cell proliferation in vitro. This effect was associated to the existence of rs6275 and rs6277 polymorphisms in the D2 gene. These results gave more insight into DA control of lung cancer cell behavior and suggested the existence of different SCLC phenotypes.
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Affiliation(s)
- Emanuela Cherubini
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Arianna Di Napoli
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Alessia Noto
- Dipartimento di Chirurgia Pietro Valdoni, Sapienza Università di Roma, Rome, Italy.,IRCCS Istituto Nazionale Tumori, Fondazione G. Pascale, Napoli, Italy
| | - Giorgia Amira Osman
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | | | - Salvatore Mariotta
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Rossella Sellitri
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Luigi Ruco
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
| | | | - Gennaro Ciliberto
- IRCCS Istituto Nazionale Tumori, Fondazione G. Pascale, Napoli, Italy
| | - Rita Mancini
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy.,Dipartimento di Chirurgia Pietro Valdoni, Sapienza Università di Roma, Rome, Italy
| | - Alberto Ricci
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Rome, Italy
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Dai W, Liu M, Zhuang X, Li Q, Wang D. Mediastinal small cell carcinoma: a unique clinical entity? Clin Transl Oncol 2015; 18:515-20. [PMID: 26329297 DOI: 10.1007/s12094-015-1398-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/19/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Mediastinal small cell carcinoma (MSCC) is a rare tumor with limited published literature. In view of diagnostic confusion pertaining to this tumor, we investigated its origin, clinical features, management and survival. METHODS Clinical data of MSCC patients were retrospectively reviewed. Eligible patients showed pathologically proven small cell carcinoma (SCC) with the primary lesions confined to the mediastinum. Survival information was collected through follow-up studies. RESULTS Among 25 MSCC patients identified, 22 were classified to have limited disease (LD), while 3 were with extensive disease (ED). The 5 patients (20%) underwent surgery and 20 patients (80%) underwent non-surgical treatment. The 4 patients with LD MSCC received chemotherapy alone, while 13 of them received chemoradiotherapy. Overall median survival time (MST) of all patients was 22 months, and the 1-, 3- and 5-year overall survival rates were 67.4, 16.8, and 8.4%, respectively. The MST of LD and ED patients separately was 23 and 8 months, respectively, with significant difference (P = 0.005). But, the MST of patients who received surgical and non-surgical treatment was 25 and 21 months, respectively, with no significant difference (P = 0.757). The MST of LD patients receiving chemotherapy and chemoradiotherapy was 12 and 29 months, respectively, but somehow did not show significant difference (P = 0.482). CONCLUSIONS Our data suggested that MSCC may be a separate clinical entity like extrapulmonary small cell carcinomas (EPSCCs). Despite, multimodal treatment is currently the main treatment option, but for patients with LD MSCC, chemoradiotherapy is recommended to be preferred treatment modality.
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Affiliation(s)
- W Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - M Liu
- Department of Thoracic Surgery, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - X Zhuang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Q Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - D Wang
- Department of Thoracic Surgery, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100021, China.
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Hamilton G, Rath B, Ulsperger E. How to target small cell lung cancer. Oncoscience 2015; 2:684-92. [PMID: 26425658 PMCID: PMC4580060 DOI: 10.18632/oncoscience.212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/15/2015] [Indexed: 12/27/2022] Open
Abstract
Small cell lung cancer (SCLC) is a highly malignant disease with dismal prognosis. Although great progress has been made in investigating genetic aberrations and putative drivers of this tumor entity, the mechanisms of rapid dissemination and acquisition of drug resistance are not clear. The majority of SCLC cases are characterized by inactivation of the tumor suppressors p53 and retinoblastoma (Rb) and, therefore, interchangeable drivers will be difficult to target successfully. Access to pure cultures of SCLC circulating tumor cells (CTCs) and study of their tumor biology has revealed a number of new potential targets. Most important, expression of chitinase-3-like-1/YKL-40 (CHI3L1) which controls expression of vascular epithelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP9) was newly described in these cells. The process switching CHI3L1-negative SCLC cells to CHI3L1-positive CTCs seems to be associated with cytokines released by inflammatory immune cells. Furthermore, these CTCs were found to promote monocyte-macrophage differentiation, most likely of the M2 tumor-promoting type, recently described to express PD-1 immune checkpoint antigen in SCLC. In conclusion, dissemination of SCLC seems to be linked to conversion of regular tumor cells to highly invasive CHI3L1-positive CTCs, which are protected by immune system suppression. Besides the classical targets VEGF, MMP-9 and PD-1, CHI3L1 constitutes a new possibly drugable molecule to retard down dissemination of SCLC cells, which may be similarly relevant for glioblastoma and other tumor entities.
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Affiliation(s)
- Gerhard Hamilton
- Ludwig Boltzmann Cluster of Translational Oncology, A-1090 Vienna, Austria
| | - Barbara Rath
- Ludwig Boltzmann Cluster of Translational Oncology, A-1090 Vienna, Austria
| | - Ernst Ulsperger
- Ludwig Boltzmann Cluster of Translational Oncology, A-1090 Vienna, Austria
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8
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Dobrovolskienė NT, Cicėnas S, Kazlauskaitė N, Mišeikytė-Kaubrienė E, Krasko JA, Ostapenko V, Pašukonienė V, Strioga MM. CD8(high)CD57(+) T-cell population as an independent predictor of response to chemoradiation therapy in extensive-stage small cell lung cancer. Lung Cancer 2015; 90:326-33. [PMID: 26319316 DOI: 10.1016/j.lungcan.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/30/2015] [Accepted: 08/01/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Tangible clinical benefit is achieved in only a relatively small proportion of extensive-stage small cell lung cancer (SCLC) patients receiving current treatment strategies. Therefore, a more personalized use of current and novel treatment approaches is of critical importance. Individualized therapy relies on the identification of specific biomarkers predictive of response to a particular type of cancer treatment. Immune-related parameters emerge as powerful biomarkers among a variety of predictors of clinical response to various types of cancer treatment. PATIENTS AND METHODS Using multicolor flow cytometry, we evaluated a predictive value of CD8(high)CD57(+) T-cell population and its immunosuppressive (FOXP3(+), NKG2A(+)) and cytotoxic (Perforin(+)) subsets in the peripheral blood of extensive-stage SCLC patients (n=82) treated with either chemotherapy-alone (n=24), or chemoradiation therapy (n=42), or receiving best supportive care (n=16). RESULTS The low level (<20%) of CD8(high)CD57(+) T cells within the peripheral blood CD8(+) T-cell population and the low level (<3%) of the immunosuppressive FOXP3-positive subset within the CD8(high)CD57(+) T-cell population were independent predictors of a better response to treatment with chemoradiation therapy, but not with chemotherapy alone or best supportive care. Importantly there was no significant survival difference between SCLC patients who were: (i) treated with chemoradiation, but had an unfavourable immune profile (≥20% of CD8(high)CD57(+) T cells and ≥3% of its FOXP3-positive subset), (ii) treated with chemotherapy alone, or (iii) received best supportive care. CONCLUSIONS We show that only a combination of chemotherapy with radiation therapy offered a considerable survival benefit that was confined to a subset of extensive-stage SCLC patients with a favourable predictive immune profile in the peripheral blood.
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Affiliation(s)
- Neringa T Dobrovolskienė
- Department of Immunology, National Cancer Institute, P. Baublio Str. 3b-321, LT-08406 Vilnius, Lithuania; Department of Immunology, State Research Institute Center for Innovative Medicine, Molėtų pl. 29, LT-08409 Vilnius, Lithuania.
| | - Saulius Cicėnas
- Department of Thoracic Surgery and Oncology, Center of Oncosurgery, National Cancer Institute, Santariskiu Str. 1, LT-08660 Vilnius, Lithuania
| | - Nijolė Kazlauskaitė
- Department of Clinical Laboratories, National Cancer Institute, Santariskiu Str. 1-126, LT-08660 Vilnius, Lithuania
| | - Edita Mišeikytė-Kaubrienė
- Department of Radiology, National Cancer Institute, Santariskiu Str. 1-43, LT-08660 Vilnius, Lithuania
| | - Jan A Krasko
- Department of Immunology, National Cancer Institute, P. Baublio Str. 3b-321, LT-08406 Vilnius, Lithuania
| | - Valerijus Ostapenko
- Department of Thoracic Surgery and Oncology, Center of Oncosurgery, National Cancer Institute, Santariskiu Str. 1, LT-08660 Vilnius, Lithuania
| | - Vita Pašukonienė
- Department of Immunology, National Cancer Institute, P. Baublio Str. 3b-321, LT-08406 Vilnius, Lithuania
| | - Marius M Strioga
- Department of Immunology, National Cancer Institute, P. Baublio Str. 3b-321, LT-08406 Vilnius, Lithuania.
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Hamilton G, Rath B, Klameth L, Hochmair M. Receptor tyrosine kinase expression of circulating tumor cells in small cell lung cancer. Oncoscience 2015; 2:629-34. [PMID: 26328272 PMCID: PMC4549360 DOI: 10.18632/oncoscience.179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/25/2015] [Indexed: 01/22/2023] Open
Abstract
Small cell lung cancer (SCLC) has a poor prognosis and is found disseminated at first presentation in the majority of cases. The cell biological mechanisms underlying metastasis and drug resistance are not clear. SCLC is characterized by high numbers of circulating tumor cells (CTCs) and we were able to expand several CTC lines ex vivo and to relate chitinase-3-like-1/YKL-40 (CHI3L1) as marker. Availability of expanded SCLC CTC cells allowed for a screening of receptor tyrosine kinases (RTKs) expressed. The metastatic CHI3L1-negative SCLC cell line SCLC26A, established from a pleural effusion was used for comparison. The CTC cell line BHGc10 was found to exhibit increased expression of RYK, AXL, Tie-1, Dtk, ROR1/2, several ephrins (Eph) and FGF/EGF receptors compared to SCLC26A. All of these RTKs have been associated with cell motility, invasion and poor prognosis in diverse cancer entities without knowledge of their association with CTCs. The identification of RYK, AXL and ROR1/2 as pseudokinases, lacking activity, seems to be related to the observed failure of RTK inhibitors in SCLC. These kinases are involved in the noncanonical WNT pathway and their expression in SCLC CTCs represents a cancer stem cell-like phenotype.
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Affiliation(s)
- Gerhard Hamilton
- Ludwig Boltzmann Cluster of Translational Oncology, Vienna, Austria
| | - Barbara Rath
- Ludwig Boltzmann Cluster of Translational Oncology, Vienna, Austria
| | - Lukas Klameth
- Ludwig Boltzmann Cluster of Translational Oncology, Vienna, Austria
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