Prognostic significance of nestin expression in patients with resected non-small cell lung cancer treated with platinum-based adjuvant chemotherapy; relationship between nestin expression and epithelial to mesenchymal transition related markers.

Although adjuvant platinum-based chemotherapy (AC) has been shown to improve survival of patients with completely resected stage II and stage IIIA non-small cell lung cancer (NSCLC), its effect is limited. Nestin is a class VI intermediate filament protein expressed in neural stem cells and several cancer cells including NSCLC. In the present study, we aimed to determine its prognostic significance concerning survival in NSCLC patients receiving AC.Nestin expression in cancer cells was immunohistochemically studied in 90 patients with completely resected stage II and stage IIIA NSCLC treated with AC and its association with clinicopathologic parameters, including ABCG2, E-cadherin, and vimentin expression, was evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of nestin expression on survival.Nestin expression was observed in 28 of the 90 (31.1%) NSCLCs. Clinicopathologically, nestin expression was associated with loss of E-cadherin expression (P = 0.006) and vimentin positive expression (P < 0.001). In survival analysis, nestin expression was significantly associated with a poorer prognosis (P = 0.028). Multivariable analysis confirmed that nestin expression is an independent prognostic indicator in NSCLC patients receiving AC (HR = 2.56; 95% CI, 1.23-5.30, P = 0.01).The present study reveals that nestin expression is a prognostic indicator of a poorer survival probability in NSCLC patients receiving AC, although its prognostic significance still requires confirmation with larger patient populations

Relationships between nestin expression and clinicopathological parameters.

<p>Relationships between nestin expression and clinicopathological parameters.</p

Representative cases of each EMT phenotype according to expression of E-cadherin and vimentin.

<p>The cases are divided into the following 4 phenotypes; complete type, incomplete type1 (hybrid type), incomplete type2 (null type), and wild type (Lo, loss; Pr, preserve; P, positive; N, negative. original magnification, ×200).</p

Cumulative survival of patients with NSCLC according to nestin expression estimated by the Kaplan-Meier method.

<p>Panel (A) and (B) shows disease-free survival (DFS) and overall survival (OS), respectively. Nestin expression is significantly associated with poorer survival in patients with resected non-small cell lung cancer treated with platinum-based adjuvant chemotherapy, whereas there was no association between DFS and nestin expression.</p

Representative images of immunohistochemical staining of NSCLC samples.

<p>(A) Nestin, (B) ABCG2, (C) E-cadherin, and (D) Vimentin show positive expression. (original magnification, ×200).</p