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Jomrich G, Gruber M, Gruber ES, Mühlbacher J, Radosavljevic S, Wilfing L, Winkler D, Prager G, Reiterer C, Kabon B, Haslacher H, Sahora K, Schindl M. Prognostic significance of mean corpuscular volume in patients with pancreatic ductal adenocarcinoma and multimodal treatment. J Visc Surg 2024; 161:99-105. [PMID: 37391288 DOI: 10.1016/j.jviscsurg.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
AIM OF THE STUDY Mean corpuscular volume (MCV) has shown mounting evidence as a prognostic indicator in a number of malignancies. The aim of this study was to examine the prognostic potential of pretherapeutic MCV among patients with pancreatic ductal adenocarcinoma (PDAC) who underwent upfront resection or resection after neoadjuvant treatment (NT). PATIENTS AND METHODS Consecutive patients with PDAC who underwent pancreatic resection between 1997 and 2019 were included in this study. Neoadjuvantly treated patients' serum MCV was measured before NT and before surgery. In patients undergoing upfront resection serum MCV was measured before surgery. Median MCV values were used as cut-off to distinguish high from low MCV values. RESULTS Five hundred and forty-nine (438 upfront resected and 111 neoadjuvantly treated) patients were included in this study. Multivariate analysis revealed, that high MCV before and after NT, were independent negative prognostic factors for overall survival (P<0.01, respectively). Furthermore, the median MCV value from before to after NT increased significantly (P<0.001, Wilcoxon signed-rank test) and was (P=0.03, Wilcoxon rank sum test) associated with tumor response to NT. CONCLUSION High MCV is an independent adverse prognostic factor in patients with resectable neoadjuvantly treated PDAC and may qualify as useful indicator to help physicians to provide personalized prognostication.
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Affiliation(s)
- Gerd Jomrich
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Maximilian Gruber
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Elisabeth S Gruber
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Jakob Mühlbacher
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Sanja Radosavljevic
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Lavinia Wilfing
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Daniel Winkler
- Vienna University of Economics and Business, Vienna, Austria
| | - Gerald Prager
- Department of Medicine 1, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Vienna, Austria
| | - Christian Reiterer
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Barbara Kabon
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria
| | - Martin Schindl
- Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna and Pancreatic Cancer Unit, Spitalgasse 23, 1090 Vienna, Austria.
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Kloesch B, Ionasz V, Paliwal S, Hruschka N, Martinez de Villarreal J, Öllinger R, Mueller S, Dienes HP, Schindl M, Gruber ES, Stift J, Herndler-Brandstetter D, Lomberk GA, Seidler B, Saur D, Rad R, Urrutia RA, Real FX, Martinelli P. A GATA6-centred gene regulatory network involving HNFs and ΔNp63 controls plasticity and immune escape in pancreatic cancer. Gut 2022; 71:766-777. [PMID: 33846140 PMCID: PMC9733634 DOI: 10.1136/gutjnl-2020-321397] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Molecular taxonomy of tumours is the foundation of personalised medicine and is becoming of paramount importance for therapeutic purposes. Four transcriptomics-based classification systems of pancreatic ductal adenocarcinoma (PDAC) exist, which consistently identified a subtype of highly aggressive PDACs with basal-like features, including ΔNp63 expression and loss of the epithelial master regulator GATA6. We investigated the precise molecular events driving PDAC progression and the emergence of the basal programme. DESIGN We combined the analysis of patient-derived transcriptomics datasets and tissue samples with mechanistic experiments using a novel dual-recombinase mouse model for Gata6 deletion at late stages of KRasG12D-driven pancreatic tumorigenesis (Gata6LateKO). RESULTS This comprehensive human-to-mouse approach showed that GATA6 loss is necessary, but not sufficient, for the expression of ΔNp63 and the basal programme in patients and in mice. The concomitant loss of HNF1A and HNF4A, likely through epigenetic silencing, is required for the full phenotype switch. Moreover, Gata6 deletion in mice dramatically increased the metastatic rate, with a propensity for lung metastases. Through RNA-Seq analysis of primary cells isolated from mouse tumours, we show that Gata6 inhibits tumour cell plasticity and immune evasion, consistent with patient-derived data, suggesting that GATA6 works as a barrier for acquiring the fully developed basal and metastatic phenotype. CONCLUSIONS Our work provides both a mechanistic molecular link between the basal phenotype and metastasis and a valuable preclinical tool to investigate the most aggressive subtype of PDAC. These data, therefore, are important for understanding the pathobiological features underlying the heterogeneity of pancreatic cancer in both mice and human.
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Affiliation(s)
- Bernhard Kloesch
- Institute of Cancer Research, Departmet of Medicine I, Medical University of Vienna, Wien, Austria
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
| | - Vivien Ionasz
- Institute of Cancer Research, Departmet of Medicine I, Medical University of Vienna, Wien, Austria
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
| | - Sumit Paliwal
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), CIBERONC, Madrid, Spain
| | - Natascha Hruschka
- Institute of Cancer Research, Departmet of Medicine I, Medical University of Vienna, Wien, Austria
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
| | | | - Rupert Öllinger
- Center for Translational Cancer Research, Technical University Munich, Munich, Germany
- Institute of Molecular Oncology and Functional Genomics, Technical University Munich, Munich, Germany
| | - Sebastian Mueller
- Center for Translational Cancer Research, Technical University Munich, Munich, Germany
- Institute of Molecular Oncology and Functional Genomics, Technical University Munich, Munich, Germany
| | - Hans Peter Dienes
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Martin Schindl
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
- Division of General Surgery, Medical University of Vienna, Wien, Austria
| | - Elisabeth S Gruber
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
- Division of General Surgery, Medical University of Vienna, Wien, Austria
| | - Judith Stift
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Dietmar Herndler-Brandstetter
- Institute of Cancer Research, Departmet of Medicine I, Medical University of Vienna, Wien, Austria
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
| | - Gwen A Lomberk
- Genomics Sciences and Precision Medicine Center and Division of Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Barbara Seidler
- Center for Translational Cancer Research, Technical University Munich, Munich, Germany
- Department of Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Gemany
| | - Dieter Saur
- Center for Translational Cancer Research, Technical University Munich, Munich, Germany
- Department of Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Gemany
- German Cancer Consortium (DKTK), German Cancer Research Consortium (DKFZ), Heidelberg, Germany
| | - Roland Rad
- Center for Translational Cancer Research, Technical University Munich, Munich, Germany
- Department of Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Gemany
- German Cancer Consortium (DKTK), German Cancer Research Consortium (DKFZ), Heidelberg, Germany
| | - Raul A Urrutia
- Genomics Sciences and Precision Medicine Center and Division of Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), CIBERONC, Madrid, Spain
- Departament de Ciènces Experimental i de la Salut, Pompeu Fabra University, Barcelona, Spain
| | - Paola Martinelli
- Institute of Cancer Research, Departmet of Medicine I, Medical University of Vienna, Wien, Austria
- Comprehensive Cancer Center, Medical University Vienna, Wien, Austria
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Gruber ES, Stadlbauer V, Pichler V, Resch-Fauster K, Todorovic A, Meisel TC, Trawoeger S, Hollóczki O, Turner SD, Wadsak W, Vethaak AD, Kenner L. To Waste or Not to Waste: Questioning Potential Health Risks of Micro- and Nanoplastics with a Focus on Their Ingestion and Potential Carcinogenicity. Expo Health 2022; 15:33-51. [PMID: 36873245 PMCID: PMC9971145 DOI: 10.1007/s12403-022-00470-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/30/2021] [Accepted: 02/11/2022] [Indexed: 05/27/2023]
Abstract
Micro- and nanoplastics (MNPs) are recognized as emerging contaminants, especially in food, with unknown health significance. MNPs passing through the gastrointestinal tract have been brought in context with disruption of the gut microbiome. Several molecular mechanisms have been described to facilitate tissue uptake of MNPs, which then are involved in local inflammatory and immune responses. Furthermore, MNPs can act as potential transporters ("vectors") of contaminants and as chemosensitizers for toxic substances ("Trojan Horse effect"). In this review, we summarize current multidisciplinary knowledge of ingested MNPs and their potential adverse health effects. We discuss new insights into analytical and molecular modeling tools to help us better understand the local deposition and uptake of MNPs that might drive carcinogenic signaling. We present bioethical insights to basically re-consider the "culture of consumerism." Finally, we map out prominent research questions in accordance with the Sustainable Development Goals of the United Nations.
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Affiliation(s)
- Elisabeth S. Gruber
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Verena Pichler
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
| | | | - Andrea Todorovic
- Materials Science and Testing of Polymers, Montanuniversitaet Leoben, Styria, Austria
| | - Thomas C. Meisel
- General and Analytical Chemistry, Montanuniversitaet Leoben, Styria, Austria
| | - Sibylle Trawoeger
- Division of Systematic Theology and its Didactics, Faculty of Catholic Theology, University of Wuerzburg, Wuerzburg, Germany
| | - Oldamur Hollóczki
- Mulliken Center for Theoretical Chemistry, University of Bonn, Bonn, Germany
| | - Suzanne D. Turner
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP UK
- Central European Institute of Technology, Masaryk University, 602 00 Brno, Czech Republic
| | - Wolfgang Wadsak
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A. Dick Vethaak
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Unit of Marine and Coastal Systems, Deltares, P.O. Box 177, 2600 MH Delft, Netherlands
| | - Lukas Kenner
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
- Division of Experimental and Laboratory Animal Pathology, Department of Pathology Medical, University of Vienna, Vienna, Austria
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
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Gruber ES, Jomrich G, Tamandl D, Gnant M, Schindl M, Sahora K. Correction: Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS One 2020; 15:e0244896. [PMID: 33373414 PMCID: PMC7771687 DOI: 10.1371/journal.pone.0244896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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5
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Gruber ES, Oberhuber G, Birner P, Schlederer M, Kenn M, Schreiner W, Jomrich G, Schoppmann SF, Gnant M, Tse W, Kenner L. Erratum: Gruber, E.S.; et al. The Oncogene AF1Q is Associated with WNT and STAT Signaling and Offers a Novel Independent Prognostic Marker in Patients with Resectable Esophageal Cancer. Cells 2019, 8, 1357. Cells 2020; 9:cells9122724. [PMID: 33371531 PMCID: PMC7766532 DOI: 10.3390/cells9122724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Elisabeth S. Gruber
- Division of General Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.S.G.); (G.J.); (S.F.S.)
- Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Georg Oberhuber
- Department of Experimental and Translational Pathology, Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (G.O.); (P.B.); (M.S.)
- PIZ—Patho im Zentrum GmbH, 3100 St. Poelten, Austria
| | - Peter Birner
- Department of Experimental and Translational Pathology, Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (G.O.); (P.B.); (M.S.)
| | - Michaela Schlederer
- Department of Experimental and Translational Pathology, Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (G.O.); (P.B.); (M.S.)
| | - Michael Kenn
- Section of Biosimulation and Bioinformatics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, 1090 Vienna, Austria; (M.K.); (W.S.)
| | - Wolfgang Schreiner
- Section of Biosimulation and Bioinformatics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, 1090 Vienna, Austria; (M.K.); (W.S.)
| | - Gerd Jomrich
- Division of General Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.S.G.); (G.J.); (S.F.S.)
- Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Sebastian F. Schoppmann
- Division of General Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.S.G.); (G.J.); (S.F.S.)
- Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - William Tse
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Correspondence: (W.T.); (L.K.); Tel.: +1-216-778-3845 (W.T.); +43-40400-51760 (L.K.)
| | - Lukas Kenner
- Department of Experimental and Translational Pathology, Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (G.O.); (P.B.); (M.S.)
- Christian Doppler Laboratory for Applied Metabolomics (CDL-AM), Medical University of Vienna, 1090 Vienna, Austria
- Institute of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
- CBmed Core Lab 2, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: (W.T.); (L.K.); Tel.: +1-216-778-3845 (W.T.); +43-40400-51760 (L.K.)
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Gruber ES, Jomrich G, Kaider A, Gnant M, Sahora K, Schindl M. Correction to: The Prognostic Index Independently Predicts Survival in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Resection. Ann Surg Oncol 2020; 27:985. [PMID: 32754799 DOI: 10.1245/s10434-020-09010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the original article there are errors in the authors' affiliations.
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Affiliation(s)
- Elisabeth S Gruber
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Gerd Jomrich
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Schindl
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. .,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Gruber ES, Kaider A, Schindl M. Reply to Comments by Sun et al. on "The Prognostic Index Independently Predicts Survival in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Resection". Ann Surg Oncol 2020; 27:946-947. [PMID: 32193720 DOI: 10.1245/s10434-020-08373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Elisabeth S Gruber
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Alexandra Kaider
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Martin Schindl
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Gruber ES, Jomrich G, Kaider A, Gnant M, Sahora K, Schindl M. The Prognostic Index Independently Predicts Survival in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Resection. Ann Surg Oncol 2020; 27:2017-2024. [PMID: 31900809 PMCID: PMC7210221 DOI: 10.1245/s10434-019-08161-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer-related inflammation is associated with tumour proliferation, maintenance and dissemination. It therefore impacts pancreatic cancer survival. The goal of this study was to examine the Prognostic Index (PI) as a prognostic biomarker for survival in patients with pancreatic ductal adenocarcinoma (PDAC). In addition, we explored factors known to interact with the immune and inflammation cascade that might interfere with the PI's strength for prognostication. METHODS Patients with PDAC undergoing resection were analysed retrospectively. The PI was calculated from preoperatively derived C-reactive protein levels and white blood count. Data were subject to correlation and survival analysis. RESULTS Of 357 patients, 235 (65.8%) patients had a PI 0, 108 (30.3%) PI 1, and 14 (3.9%) PI 2. Median (quartiles) survival with a high PI (group 1 + 2) was 13.2 months (7.7-27.0), compared with 18.7 months (10.2-35.4) with a low PI (group 0; p = 0.012). The PI proved to be an independent prognostic factor for cancer-specific survival (p = 0.003) adjusted for conventional prognostic factors. Prognostic strength was influenced by the presence of a bile stent (p = 0.032). CONCLUSIONS The PI is a strong and solid independent prognostic tool for survival in patients with PDAC undergoing resection. Preoperative survey of inflammatory activity as provided by the use of a biomarker like the PI may help to identify those patients at risk of a poor prognosis.
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Affiliation(s)
- Elisabeth S Gruber
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Gerd Jomrich
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Schindl
- Pancreatic Cancer Unit, Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Gruber ES, Oberhuber G, Birner P, Schlederer M, Kenn M, Schreiner W, Jomrich G, Schoppmann SF, Gnant M, Tse W, Kenner L. The Oncogene AF1Q is Associated with WNT and STAT Signaling and Offers a Novel Independent Prognostic Marker in Patients with Resectable Esophageal Cancer. Cells 2019; 8:E1357. [PMID: 31671695 PMCID: PMC6912824 DOI: 10.3390/cells8111357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/24/2022] Open
Abstract
AF1q impairs survival in hematologic and solid malignancies. AF1q expression is associated with tumor progression, migration, and chemoresistance, and acts as a transcriptional co-activator in WNT and STAT signaling. This study evaluates the role of AF1q in patients with resectable esophageal cancer (EC). A total of 278 patients operated on for esophageal cancer were retrospectively included, and the expression of AF1q, CD44, and pYSTAT3 was analyzed following immunostaining. Quantified data were processed to correlational and survival analysis. In EC patients, an elevated expression of AF1q was associated with CD44 (p = 0.004), and pYSTAT3 (p = 0.0002). High AF1q expression in primary tumors showed high AF1q expression in the corresponding lymph nodes (p= 0.016). AF1q expression was higher after neoadjuvant therapy (p= 0.0002). Patients with AF1q-positive EC relapsed and died earlier compared to patients with AF1q-negative EC (disease-free survival (DFS), p= 0.0005; disease-specific survival (DSS), p= 0.003); in the multivariable Cox regression model, AF1q proved to be an independent prognostic marker (DFS, p= 0.01; DSS, p= 0.03). AF1q is associated with WNT and STAT signaling; it impairs and independently predicts DFS and DSS in patients with resectable EC. The testing of AF1q could facilitate prognosis estimation and provide a possibility of identifying the patients responsive to the therapeutic blockade of its oncogenic downstream targets.
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Affiliation(s)
- Elisabeth S Gruber
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
| | - Georg Oberhuber
- Institute of Pathology, Department of Experimental and Translational Pathology, Medical University of Vienna, 1090 Vienna, Austria.
- PIZ - patho im zentrum GmbH, 3100 St. Poelten, Lower Austria, Austria.
| | - Peter Birner
- Institute of Pathology, Department of Experimental and Translational Pathology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Michaela Schlederer
- Institute of Pathology, Department of Experimental and Translational Pathology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Michael Kenn
- Section of Biosimulation and Bioinformatics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, 1090 Vienna, Austria.
| | - Wolfgang Schreiner
- Section of Biosimulation and Bioinformatics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, 1090 Vienna, Austria.
| | - Gerd Jomrich
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
| | - Sebastian F Schoppmann
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
| | - Michael Gnant
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
| | - William Tse
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA.
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville, School of Medicine, Louisville, KY 40202, USA.
| | - Lukas Kenner
- Institute of Pathology, Department of Experimental and Translational Pathology, Medical University of Vienna, 1090 Vienna, Austria.
- Christian Doppler Laboratory for Applied Metabolomics (CDL-AM), Medical University of Vienna, 1090 Vienna, Austria.
- Institute of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria.
- CBmed Core Lab 2, Medical University of Vienna, 1090 Vienna, Austria.
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Kadletz LC, Brkic FF, Jank BJ, Schneider S, Cede J, Seemann R, Gruber ES, Gurnhofer E, Heiduschka G, Kenner L. AF1q Expression Associates with CD44 and STAT3 and Impairs Overall Survival in Adenoid Cystic Carcinoma of the Head and Neck. Pathol Oncol Res 2019; 26:1287-1292. [PMID: 31273546 PMCID: PMC7242261 DOI: 10.1007/s12253-019-00696-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/23/2019] [Indexed: 11/27/2022]
Abstract
Salivary gland malignancies of the head and neck form a heterogeneous group. Adenoid cystic carcinomas are an aggressive entity of salivary gland malignancies characterized by frequent distant metastases and poor response to radio- and chemotherapy. AF1Q is a MLL fusion partner, which can activate Wnt and STAT3 signaling. Recently, overexpression of AF1q has been identified as a poor prognosticator in patients of different malignancies. A total of 46 patients with adenoid cystic carcinoma were immunohistochemically evaluated for expression of AF1q and clinical outcome was analyzed in this context. Additionally, STAT3 and the Wnt downstream target CD44 were investigated and correlated with AF1q. AF1q was overexpressed in 52.2%. Overexpression of AF1q was associated with poorer overall survival (p = 0.03). Additionally, lymph node metastases and solid tumor parts were more frequently observed in AF1qhigh patients (p = 0.07 and 0.05, respectively). AF1q did not influence the occurrence of distant metastases. Expression of AF1q was associated with higher levels of STAT3 and CD44 (p = 0.003 and 0.006, respectively). AF1q is a novel prognostic marker for poor overall survival in adenoid cystic carcinoma patients. The deleterious effects on survival may be a result of promotion of the STAT3 and Wnt pathway.
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Affiliation(s)
- Lorenz C Kadletz
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
| | - Faris F Brkic
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard J Jank
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Sven Schneider
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Cede
- Department of Craniomaxillo and Facial Surgery, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- Department of Craniomaxillo and Facial Surgery, Medical University of Vienna, Vienna, Austria
| | - Elisabeth S Gruber
- Department of General Surgery, Division of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Gurnhofer
- Department of Experimental Pathology and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Kenner
- Department of Experimental Pathology and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.
- Department of Experimental Pathology and Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria.
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11
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Gruber ES, Jomrich G, Tamandl D, Gnant M, Schindl M, Sahora K. Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS One 2019; 14:e0215915. [PMID: 31059520 PMCID: PMC6502449 DOI: 10.1371/journal.pone.0215915] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background Incidence and mortality of pancreatic ductal adenocarcinoma (PDAC) are on the rise. Sarcopenia and sarcopenic obesity have proven to be prognostic factors in different types of cancers. In the context of previous findings, we evaluated the impact of body composition in patients undergoing surgery in a national pancreatic center. Methods Patient’s body composition (n = 133) was analyzed on diagnostic CT scans and defined as follows: Skeletal muscle index ≤38.5 cm2/m2 (women), ≤52.4 cm2/m2 (men); obesity was classified as BMI ≥25kg/m2. Results Sarcopenia showed a negative impact on overall survival (OS; 14 vs. 20 months, p = 0.016). Sarcopenic patients suffering from obesity showed poorer OS compared to non-sarcopenic obese patients (14 vs. 23 months, p = 0.007). Both sarcopenia and sarcopenic obesity were associated with sex (p<0.001 and p = 0.006; males vs. females 20% vs. 38% and 12% vs. 38%, respectively); sarcopenia was further associated with neoadjuvant treatment (p = 0.025), tumor grade (p = 0.023), weight loss (p = 0.02) and nutritional depletion (albumin, p = 0.011) as well as low BMI (<25 kg/m2, p = 0.038). Sarcopenic obese patients showed higher incidence of major postoperative complications (p<0.001). In addition, sarcopenia proved as an independent prognostic factor for OS (p = 0.031) in the multivariable Cox Regression model. Conclusion Patients with sarcopenia and sarcopenic obesity undergoing resection for PDAC have a significantly shorter overall survival and a higher complication rate. The assessment of body composition in these patients may provide a broader understanding of patients’ individual condition and guide specific supportive strategies in patients at risk.
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Affiliation(s)
- Elisabeth S. Gruber
- Division of General Surgery, Department of Surgery, Pancreatic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- * E-mail: (ESG); (KS)
| | - Gerd Jomrich
- Division of General Surgery, Department of Surgery, Pancreatic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Division of General Surgery, Department of Surgery, Pancreatic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Schindl
- Division of General Surgery, Department of Surgery, Pancreatic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Division of General Surgery, Department of Surgery, Pancreatic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- * E-mail: (ESG); (KS)
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12
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Gruber ES, Jomrich G, Sahora K, Gnant M, Schindl M. Prognostic Index, but Not Body Composition, Is an Accurate Tool for Preoperative Outcome Estimation in Patients with Primary Resectable Pancreatic Ductal Adenocarcinoma. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Jomrich G, Gruber ES, Winkler D, Hollenstein M, Gnant M, Schindl M, Sahora K. Systemic Immune-Inflammation Index Predicting Poor Outcome in Pancreatic Cancer Patients. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Schmidt S, Schumacher N, Schwarz J, Tangermann S, Kenner L, Schlederer M, Sibilia M, Linder M, Altendorf-Hofmann A, Knösel T, Gruber ES, Oberhuber G, Bolik J, Rehman A, Sinha A, Lokau J, Arnold P, Cabron AS, Zunke F, Becker-Pauly C, Preaudet A, Nguyen P, Huynh J, Afshar-Sterle S, Chand AL, Westermann J, Dempsey PJ, Garbers C, Schmidt-Arras D, Rosenstiel P, Putoczki T, Ernst M, Rose-John S. ADAM17 is required for EGF-R-induced intestinal tumors via IL-6 trans-signaling. J Exp Med 2018; 215:1205-1225. [PMID: 29472497 PMCID: PMC5881468 DOI: 10.1084/jem.20171696] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/22/2017] [Accepted: 01/22/2018] [Indexed: 02/06/2023] Open
Abstract
Schmidt et al. show that loss of the membrane-bound metalloprotease ADAM17 led to impaired intestinal cancer development in the murine APCmin/+ model, which also depended on IL-6 trans-signaling via the soluble IL-6R and could be blocked by the specific IL-6 trans-signaling inhibitor sgp130Fc. Colorectal cancer is treated with antibodies blocking epidermal growth factor receptor (EGF-R), but therapeutic success is limited. EGF-R is stimulated by soluble ligands, which are derived from transmembrane precursors by ADAM17-mediated proteolytic cleavage. In mouse intestinal cancer models in the absence of ADAM17, tumorigenesis was almost completely inhibited, and the few remaining tumors were of low-grade dysplasia. RNA sequencing analysis demonstrated down-regulation of STAT3 and Wnt pathway components. Because EGF-R on myeloid cells, but not on intestinal epithelial cells, is required for intestinal cancer and because IL-6 is induced via EGF-R stimulation, we analyzed the role of IL-6 signaling. Tumor formation was equally impaired in IL-6−/− mice and sgp130Fc transgenic mice, in which only trans-signaling via soluble IL-6R is abrogated. ADAM17 is needed for EGF-R–mediated induction of IL-6 synthesis, which via IL-6 trans-signaling induces β-catenin–dependent tumorigenesis. Our data reveal the possibility of a novel strategy for treatment of colorectal cancer that could circumvent intrinsic and acquired resistance to EGF-R blockade.
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Affiliation(s)
- Stefanie Schmidt
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Neele Schumacher
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Jeanette Schwarz
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Simone Tangermann
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Lukas Kenner
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria.,Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Experimental and Laboratory Animal Pathology, Medical University Vienna, Vienna, Austria
| | - Michaela Schlederer
- Department of Experimental and Laboratory Animal Pathology, Medical University Vienna, Vienna, Austria
| | - Maria Sibilia
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Markus Linder
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | | | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Elisabeth S Gruber
- Department of General Surgery, Division of Surgery and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Georg Oberhuber
- Department of Experimental and Laboratory Animal Pathology, Medical University Vienna, Vienna, Austria
| | - Julia Bolik
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Ateequr Rehman
- Institute of Clinical Molecular Biology, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Anupam Sinha
- Institute of Clinical Molecular Biology, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Juliane Lokau
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Philipp Arnold
- Anatomisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Anne-Sophie Cabron
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Friederike Zunke
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | | | - Adele Preaudet
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Nguyen
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Huynh
- Olivia Newton-John Cancer Research Institute and La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia
| | - Shoukat Afshar-Sterle
- Olivia Newton-John Cancer Research Institute and La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia
| | - Ashwini L Chand
- Olivia Newton-John Cancer Research Institute and La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia
| | | | - Peter J Dempsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Christoph Garbers
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Dirk Schmidt-Arras
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian Albrechts Universität Kiel, Kiel, Germany
| | - Tracy Putoczki
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthias Ernst
- Olivia Newton-John Cancer Research Institute and La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia
| | - Stefan Rose-John
- Biochemisches Institut, Christian Albrechts Universität Kiel, Kiel, Germany
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15
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Gruber ES, Birner P, Merkel O, Bergmann MM, Schoppmann SF, Park J, Moriggl R, Tse W, Kenner L. Abstract 4463: The coactivator oncogene AF1Q associates with STAT3 activation downstream of MET action in gastro-esophageal cancer patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
AF1Q was initially identified as an oncogene in acute myeloid leukemia. In breast cancer, AF1q mediates tumor progression by boosting STAT3-signalling. In addition, AF1q enhances wnt-signalling resulting in transcriptional activation of CD44 and promotes tumor cell proliferation, migration and chemo-resistance. In gastrointestinal malignancies both pathways are linked to enhanced MET tyrosine kinase receptor action, accelerating tumor progression and metastases. We showed that Af1q overexpression in the gastro-esophageal cancer cell lines SK-GT-4, FLO-1 and OE33 led to increased sphere formation and increased invasive capacity in the case of FLO-1 and OE33. We investigated the role of AF1q in a retrospective collective of 460 resected gastro-esophageal cancer specimens (74.3% adenocarcinomas (AC), 25.7% esophageal squamous cell cancers (SCC)). With respect to topographic location, 40.4% of tumors were esophageal (EC), 20% gastro-esophageal (GEC) and 39.6% gastric cancers (GC). Immunohistochemistry revealed overexpression of AF1q in 205, and of CD44 in 114 patient tumor samples. AF1q overexpression was found more often in EC/GEC as compared to GC (p=0.007) and associated with HER2 (p=0.035), pySTAT3 (p<0.001) and MET (p=0.004) expression as well as neoadjuvant chemotherapy (p<0.001). AF1q and CD44 overexpression correlated in the overall group (p<0.001) and in AC (p<0.001). In SCC CD44 was expressed more frequently compared to AC (p<0.001). Analysis of the matched primary and metastatic tumors revealed that primary AF1q-positive tumor samples were largely overlapping with AF1q-positive tumors lymph node metastases (23/32) and distant metastases (6/7). AF1q overexpression correlated with shorter disease free survival (DFS) (p=0.003) and shorter disease specific survival (DSS) (p=0.036), but overall survival (OS) was similar (p=0.117). In a subgroup analysis a shorter OS was observed in EC/GEC (p=0.03, log rank test). In a Cox regression model AF1q and CD44 expression was associated with shorter DFS (p<0.001 and p=0.025) and DSS (p=0.005 and p=0.035), but OS remained unchanged. Prognostic significance was limited to AF1q (p=0.003 and p=0.04, respectively). We conclude, that AF1q overexpression is associated with progression and metastases in GEC. AF1q and downstream pathway markers such as pySTAT3- as well as CD44 and MET are linked with AF1q expression. Therefore we propose AF1q as a novel prognostic marker for GECs.
Citation Format: Elisabeth S. Gruber, Peter Birner, Olaf Merkel, Michael M. Bergmann, Sebastian F. Schoppmann, Jino Park, Richard Moriggl, William Tse, Lukas Kenner. The coactivator oncogene AF1Q associates with STAT3 activation downstream of MET action in gastro-esophageal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4463. doi:10.1158/1538-7445.AM2017-4463
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Affiliation(s)
- Elisabeth S. Gruber
- 1University Clinic for Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Birner
- 2Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - Olaf Merkel
- 2Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - Michael M. Bergmann
- 1University Clinic for Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Jino Park
- 3James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Richard Moriggl
- 4University Vienna, Ludwig Boltzmann Institute, Vienna, Austria
| | - William Tse
- 3James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Lukas Kenner
- 5Institute of Laboratory Animal Pathology, University of Veterinary Medicine, Vienna, Austria
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