Abstract
ObjectiveCD47 is an antiphagocytic molecule that contributes to tumor cell resistance in host immune surveillance. CD47 overexpression correlated with tumor progression and shorter survival in lung cancer. However, the expression and functional significance of CD47 in Non‐Small Cell Lung Cancer (NSCLC) has not been completely understood.Materials and MethodsIn this retrospective study, CD47 expression was immunohistochemically examined in tumor biopsies from 169 NSCLC patients. The association of CD47 levels (H‐score) with clinicopathological characteristics and survival outcomes was evaluated.ResultsCD47 protein was detected in 84% of patients with a median expression of 80% (0‐100). Tumor CD47 levels above 1% and 50% were found in 84% and 65.7% of patients, respectively. While, median CD47 staining index was 160 (0‐300). Patients were divided into two groups according to CD47 expression (high or low), using a cutoff value of 150. High CD47 expression was associated with wood smoke exposure (71.1% vs 28.9%, P = .013) and presence of EGFR (+) mutations (66.7% vs 33.3%, P = .04). Survival analysis carried out in the whole population did not show any association of CD47 expression and survival outcome. However, in patients with EGFR (+) mutations, CD47 expression was associated with higher progression‐free survival (PFS) (12.2 vs. 4.4 months, P = .032). When the survival analysis was performed according to CD47 levels (cut off value: 150), both, PFS and overall survival (OS) were shortened in patients with a high expression of CD47 (10.7 vs. NR, P = .156) and (29.2 vs. NR months P = .023), respectively.ConclusionsCD47 overexpression is not a prognostic factor for PFS and OS in NSCLC patients. However, the presence of EGFR mutations and high expression of CD47 were associated with shortened PFS and OS. Coexpression of these markers represents a potential biomarker and characterizes a therapeutic niche for lung cancer.
Highlights
Lung cancer (LC) remains the leading cause of cancer-related deaths worldwide, with approximately 2.5 million new cases and 1.5 million deaths per year.[1]
We have previously reported that Cluster of differentiation 47 (CD47) overexpression in whole-blood samples from Non-Small Cell Lung Cancer (NSCLC) patients is associated with poor overall survival (OS), and its expression on neutrophil surface prevents apoptosis and phagocytic clearance of these cells.[14]
We evaluated CD47 expression by IHC in NSCLC tumor cells based on H-score from Epidermal Growth Factor (EGFR) FLEX trial and found an optimal cutoff ≥ 150.21 Tumor cells have shown an expression level of ≥1% in 84% of patients, of which 65.5% had an expression ≥50%; CD47 was not a prognosis factor that response to treatment or a longer survival
Summary
Lung cancer (LC) remains the leading cause of cancer-related deaths worldwide, with approximately 2.5 million new cases and 1.5 million deaths per year.[1] Non-Small Cell Lung Cancer (NSCLC) accounts for approximately 85% of all cases with less than 21% of overall survival (OS) rate to 5 years.[2] Development of targeted therapy and immunotherapy has revolutionized NSCLC treatment. We determined CD47 expression by immunohistochemistry and its relation with clinical characteristics, genetic alterations and survival outcomes
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