Abstract
The prognostic role of thyroid transcription factor-1 (TTF-1) expression in lung cancer has been assessed but with inconsistent results. The present study aimed to evaluate the prognostic value of TTF1 expression in advanced non-squamous non-small cell lung cancer (NSCLC). In this retrospective study, patients with stage IIIB-IV non-squamous NSCLC were enrolled. Progression free survival (PFS) and overall survival (OS) were assessed according to TTF1 expression status, age categories (≤60 vs >60 years), gender, performance status (PS) (0-2 vs 3-4), type of 1st line chemotherapy (pemetrexed containing vs others) and EGFR status. A total of 120 patients were included. In univariate analysis, PFS was improved in patients with PS 0-2 (7.0 vs 2.0 months, p=0.002) and those who received pemetrexed-containing chemotherapy (9.2 vs 5.8 months, p=0.004). OS was improved in female patients (23.0 vs 8.7 months, p<0.0001), PS 0-2 (14.4 vs 2.0 months, p<0.0001), those with pemetrexed-containing chemotherapy (17.0 vs 11.0 months, p=0.019), TTF1-positive (12.8 vs 5.8 months, p=0.011) and EGFR- mutant patients (23.0 vs 11.7 months, p=0.006). In multivariate analysis, male gender (HR=2.34, p=0.025) and non-pemetrexed containing therapy (HR=2.24, p=0.022) were independent predictors of worse PFS. Wild EGFR status (HR=2.49, p=0.015) and male gender (HR=2.78, p=0.008) were predictors of worse OS. Pemetrexed-containing therapy significantly improved PFS while OS was improved in EGFR mutant patients. Female patients had better PFS and OS. TTF1 expression was not a prognostic marker in advanced non-squamous NSCLC.
Highlights
Lung cancer is the most common cause of cancerrelated mortality worldwide and non-small cell Lung cancer (NSCLC) accounts for more than 85% of primary lung cancers (Li et al, 2012)
Progression free survival (PFS) and overall survival (OS) were assessed using survival analyses (Kaplan-Meier curves) and the differences in survival distributions according to transcription factor-1 (TTF1) expression status, age categories (≤60 vs >60 years), gender, performance status (PS) (0-2 vs 3-4), site of metastasis, type of 1st line therapy, receipt of maintenance therapy and epidermal growth factor receptor (EGFR) status were evaluated via Log Rank (Mantel-Cox) test
Thyroid transcription factor-1 (TTF1) is critical for the regulation of expression of multiple genes involved in lung development (Anagnostou et al, 2009)
Summary
Lung cancer is the most common cause of cancerrelated mortality worldwide and non-small cell Lung cancer (NSCLC) accounts for more than 85% of primary lung cancers (Li et al, 2012). The prognostic value of TTF1 expression in lung cancer patients has been evaluated in several studies, incorporating mainly local or loco-regional stages; results were conflicting and no consensus has been reached (Zhan et al, 2013). Data from these studies was limited by small sample size, patient heterogeneity and different immune-histochemical techniques used to detect TTF1 (Saad et al, 2004; Berghmans et al, 2006). The present study aims to evaluate the value of TTF1 expression as a prognostic factor in advanced NSCLC patients and whether its potential prognostic value will be retained after adjusting for other prognostic variables
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