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Keratinization of Lung Squamous Cell Carcinoma Is Associated with Poor Clinical Outcome

View Article: PubMed Central - PubMed

ABSTRACT

Background: Although the World Health Organization (WHO) classification of lung squamous cell carcinoma (SCC) was revised in 2015, its clinical implications for lung SCC subsets remain unclear. We investigated whether the morphologic characteristics of lung SCC, including keratinization, were associated with clinical parameters and clinical outcome of patients.

Methods: A total of 81 patients who underwent curative surgical resection of diagnosed lung SCC, were enrolled in this study. Attributes such as keratinization, tumor budding, single cell invasion, and nuclear size within the tumor, as well as immunohistochemistry of Bcl-xL and pS6 expressions, were evaluated.

Results: The keratinizing and nonkeratinizing subtypes did not differ with respect to age, sex, TNM stage, and morphologic parameters such as nuclear diameter, tumor budding, and single cell invasion at the tumor edge. Most patients with the keratinizing subtype (98.0%) had a history of smoking, whereas the nonkeratinizing group had a relatively higher proportion of never-smokers relative to the keratinizing group (24.0% vs. 2.0%; p=0.008, chi-square test). Expression of pS6 (a surrogate marker of mammalian target of rapamycin complex 1 [mTORC1] signaling that regulates keratinocyte differentiation), and Bcl-xL (a key anti-apoptotic molecule that may inhibit keratinization), did not correlate significantly with the presence of keratinization. Patients with the keratinizing subtype had a significantly shorter overall survival (85.2 months vs. 135.7 months, p=0.010, log-rank test), and a multivariate analysis showed that keratinization was an independent, poor prognostic factor (hazard ratio, 2.389; 95% confidence interval, 1.090–5.233; p=0.030).

Conclusion: In lung SCC, keratinization is associated with a poor prognosis, and might be associated with smoking.

No MeSH data available.


Related in: MedlinePlus

Disease-free survival (A) and overall survival (B) of patients with lung squamous cell carcinoma according to the keratinization status (p-values were obtained using the log-rank test).
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Figure 3: Disease-free survival (A) and overall survival (B) of patients with lung squamous cell carcinoma according to the keratinization status (p-values were obtained using the log-rank test).

Mentions: We next analyzed the clinical outcomes of lung SCC according to keratinization. Although the keratinizing subtype was associated with a reduced DFS, this difference did not reach statistical significance (119.6 months vs. 122.7 months, p=0.459, log-rank test). However, the keratinizing subtype was associated with significantly shorter OS relative to the non-keratinizing subtype (85.2 months vs. 135.7 months, p=0.010, log-rank test) (Figure 3).


Keratinization of Lung Squamous Cell Carcinoma Is Associated with Poor Clinical Outcome
Disease-free survival (A) and overall survival (B) of patients with lung squamous cell carcinoma according to the keratinization status (p-values were obtained using the log-rank test).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392489&req=5

Figure 3: Disease-free survival (A) and overall survival (B) of patients with lung squamous cell carcinoma according to the keratinization status (p-values were obtained using the log-rank test).
Mentions: We next analyzed the clinical outcomes of lung SCC according to keratinization. Although the keratinizing subtype was associated with a reduced DFS, this difference did not reach statistical significance (119.6 months vs. 122.7 months, p=0.459, log-rank test). However, the keratinizing subtype was associated with significantly shorter OS relative to the non-keratinizing subtype (85.2 months vs. 135.7 months, p=0.010, log-rank test) (Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Although the World Health Organization (WHO) classification of lung squamous cell carcinoma (SCC) was revised in 2015, its clinical implications for lung SCC subsets remain unclear. We investigated whether the morphologic characteristics of lung SCC, including keratinization, were associated with clinical parameters and clinical outcome of patients.

Methods: A total of 81 patients who underwent curative surgical resection of diagnosed lung SCC, were enrolled in this study. Attributes such as keratinization, tumor budding, single cell invasion, and nuclear size within the tumor, as well as immunohistochemistry of Bcl-xL and pS6 expressions, were evaluated.

Results: The keratinizing and nonkeratinizing subtypes did not differ with respect to age, sex, TNM stage, and morphologic parameters such as nuclear diameter, tumor budding, and single cell invasion at the tumor edge. Most patients with the keratinizing subtype (98.0%) had a history of smoking, whereas the nonkeratinizing group had a relatively higher proportion of never-smokers relative to the keratinizing group (24.0% vs. 2.0%; p=0.008, chi-square test). Expression of pS6 (a surrogate marker of mammalian target of rapamycin complex 1 [mTORC1] signaling that regulates keratinocyte differentiation), and Bcl-xL (a key anti-apoptotic molecule that may inhibit keratinization), did not correlate significantly with the presence of keratinization. Patients with the keratinizing subtype had a significantly shorter overall survival (85.2 months vs. 135.7 months, p=0.010, log-rank test), and a multivariate analysis showed that keratinization was an independent, poor prognostic factor (hazard ratio, 2.389; 95% confidence interval, 1.090–5.233; p=0.030).

Conclusion: In lung SCC, keratinization is associated with a poor prognosis, and might be associated with smoking.

No MeSH data available.


Related in: MedlinePlus