SULF2 Expression Is a Potential Diagnostic and Prognostic Marker in Lung Cancer.

Renato Franco,Natalie S Lui,David M Jablons,Yi-Wei Yang,Hassan Lemjabbar-Alaoui,Petra Buchanan,Annemieke Van Zante

doi:10.1371/journal.pone.0148911

Renato Franco, Natalie S Lui + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0148911

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Journal: PloS one	Publication Date: Feb 16, 2016
Citations: 16	License type: CC BY 4.0

Affiliation: University of California, San Francisco

Abstract

AimsLung cancer is one of the most deadly cancers; median survival from diagnosis is less than one year in those with advanced disease. Novel lung cancer biomarkers are desperately needed. In this study, we evaluated SULF2 expression by immunohistochemistry and its association with overall survival in a cohort of patients with non-small cell lung cancer (NSCLC). We also looked for the presence of SULF2 protein in plasma to evaluate its potential as an early detection biomarker for NSCLC.MethodsWe identified patients who underwent surgical resection for pulmonary adenocarcinoma or squamous cell carcinoma at our institution. A section from each paraffin-embedded specimen was stained with a SULF2 antibody. A pathologist determined the percentage and intensity of tumor cell staining. Survival analysis was performed using a multivariate Cox proportional hazards model. Using a novel SULF2 ELISA assay, we analyzed plasma levels of SULF2 in a small cohort of healthy donors and patients with early stage NSCLC.ResultsSULF2 staining was present in 82% of the lung cancer samples. Squamous cell carcinomas had a higher mean percentage of staining than adenocarcinomas (100% vs. 60%; p<0.0005). After adjusting for age, sex, race, histologic type, stage, and neoadjuvant therapy, there was a non-significant (31%; p = 0.65) increase in the risk of death for patients with adenocarcinoma with SULF2 staining in tumor cells. In contrast, there was a significant decrease in the risk of death (89%; p = 0.02) for patients with squamous cell carcinoma with SULF2 staining in tumor cells. SULF2 protein was present in plasma of patients with early stage NSCLC, and soluble SULF2 levels increased with age. Finally, plasma SULF2 levels were significantly elevated in early stage NSCLC patients, compared to healthy controls.ConclusionsTumor expression of SULF2 may affect prognosis in NSCLC, while blood SULF2 levels may have a significant role in the diagnosis of this fatal disease.

Highlights

Lung cancer is the most frequently diagnosed non-cutaneous malignancy and the leading cause of cancer death worldwide [1,2,3,4]
There was a significant decrease in the risk of death (89%; p = 0.02) for patients with squamous cell carcinoma with SULF2 staining in tumor cells
SULF2 protein was present in plasma of patients with early stage non-small cell lung carcinoma (NSCLC), and soluble SULF2 levels increased with age

Summary

Introduction

Lung cancer is the most frequently diagnosed non-cutaneous malignancy and the leading cause of cancer death worldwide [1,2,3,4]. The majority of lung cancers are attributable to cigarette smoking, which exposes the airways to tobacco smoke carcinogens. 90% of all lung cancer-related deaths are caused by tobacco use [6]. Lung cancer is a heterogeneous disease involving somatic mutations and epigenetic dysregulation of a number of signaling pathways. Despite the improvements in diagnosis and therapy made during the past 25 years, the prognosis for patients with lung cancer is still poor [8,9]. Further understanding of the molecular basis of lung cancer, including the discovery of disease-specific biomarkers, would greatly improve our ability to diagnose, provide prognostic information, and potentially guide treatment of patients

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