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Molecular Biology Laboratory, Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| ABSTRACT |
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15%) was observed in 17 of the 77
(22%) tumors. Patients whose tumors expressed a high level of cyclin
B1 had a significantly shorter survival time than patients whose tumors
expressed a low level of cyclin B1 (P = 0.02, log-rank test). Interestingly, overexpression of cyclin B1 was
more frequently observed in tumors with squamous cell histology than in
tumors with other histological cell types (P = 0.01, Fishers exact test). A subgroup analysis revealed that
cyclin B1 overexpression seems to be an adverse prognostic factor only
in patients with squamous cell carcinoma (SCC) of the lung
(P = 0.02, log-rank test). Our data
indicate that cyclin B1 may be dysregulated in non-small cell lung
cancer, particularly in the SCC subtype, and that a high level of
cyclin B1 expression may be a prognostic marker for patients with
early-stage SCC of the lung. | Introduction |
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Altered regulation of the cell cycle is a hallmark of human cancers (3) . Cell cycle progression is governed by a series of cyclins and cdks. Individual cyclins act at different phases of the cell cycle by binding and activating corresponding cdks. Of the various cyclin/cdk complexes involved in cell cycle regulation, cyclin D1/cdk4/6 and cyclin B1/Cdc2 are of particular interest because the former directs G1-S-phase transition and the latter controls G2-M-phase checkpoint surveillance, which are in turn essential for DNA synthesis and cell proliferation. Dysregulated expression of these cyclins, cdks, or both may lead to uncontrolled cell growth and malignant transformation. Overexpression and/or amplification of cyclin D1 has been reported in a large variety of human cancers, including those of the esophagus, head and neck, lung, liver, and breast (3) and is reported to be of prognostic importance in patients with most of these tumor types (4, 5, 6) . Overexpression of cyclin B1 has been reported more recently in breast, colon, prostate, oral, and esophageal carcinomas (7, 8, 9, 10, 11) . Its prognostic value has been suggested in patients with SCC of the esophagus (11) . However, little is known about cyclin B1 expression status in lung cancer and its potential clinical application in this tumor type.
To determine whether cyclin B1 expression is dysregulated in early-stage NSCLC and whether it can be used as a prognostic marker in patients with NSCLC, we examined immunohistochemically the expression pattern of cyclin B1 in 77 patients with pathological stage I NSCLC. We found that cyclin B1 was overexpressed in about 20% of the tumors analyzed (34% of SCC and 12% of non-SCC tumors) and that this overexpression is an adverse prognostic factor of survival time for patients with stage I NSCLC.
| Materials and Methods |
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The cyclin B1 labeling index was defined as the percentage of tumor cells displaying cytoplasmic or nuclear immunoreactivity and calculated by counting the number of cyclin B1-stained tumor cells among at least 1000 tumor cells for each section. Similarly, the Ki-67 proliferative index was defined as the percentage of nuclear-stained cells among 1000 or more tumor cells. Representative areas of each tissue section were selected, and cells were counted in at least four fields (at x400) in these areas. All slides were scored concomitantly by a pathologist (S. J. J.) and another investigator (J-C. S.).
Statistical Analysis.
Survival curves were estimated by the Kaplan-Meier method, and the
resulting curves were compared using the log-rank test. Fishers exact
test and the
2 test were used to analyze the
association between two categorical variables. P < 0.05 was considered to be statistically significant.
Immunohistochemical analysis was performed in a blinded manner with
respect to the clinical information of the subjects. The Pearson
correlation coefficient was used to test the strength of association
between continuous variables (i.e., cyclin B1 and Ki-67).
| Results |
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15% of the cells were positive for cyclin B1,
the case was considered to have cyclin B1 overexpression. For Ki-67
staining, cases with
25% positive cells were considered to have high
expression of Ki-67 based on previous reports (12, 13, 14)
. As
shown in Fig. 2
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We subsequently analyzed the relationship between cyclin B1 expression
and length of survival. Fig. 3A
shows a comparison of the Kaplan-Meier survival curves
between patients whose tumors expressed a high level of cyclin B1 and
those whose tumors had low cyclin B1 expression. Patients with tumors
that overexpressed cyclin B1 had significantly shorter survival times
than patients with tumors that displayed low levels of cyclin B1
(P = 0.02, log-rank test). About 60% of the
patients whose tumors had a low cyclin B1 expression were alive at 5
years compared with only 30% of the patients whose tumors had high
cyclin B1 expression (Table 1)
. The prognostic significance of cyclin
B1 expression was further explored in terms of the major histological
subtypes. Cyclin B1 overexpression was a significant adverse prognostic
factor among patients with tumors of the SCC subtype
(P = 0.02, log-rank test; Fig. 3B
)
as opposed to patients with adenocarcinoma (Fig. 3C
).
Because Ki-67 and cyclin B1 expression had a weak correlation, the
prognostic significance of Ki-67 was also explored, but no
statistically significant effect was observed (Fig. 3D
).
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| Discussion |
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In the present study, we demonstrated that cyclin B1 is overexpressed
in a significant fraction of NSCLCs. Overall, 17 of the 77 (22%)
tumors expressed cyclin B1 in
15% of tumor cells. Interestingly,
cyclin B1 expression was different when SCC tumors were compared with
non-SCC samples. High cyclin B1 expression was observed in 34% of SCC
tumors but in only 12% of tumors with other histological subtypes
(Table 1)
. Furthermore, our data show that high cyclin B1 expression is
a significant unfavorable prognostic factor in patients with stage I
NSCLC. The fact that all of the patients in the study were treated at a
single institute and received lengthy follow-up care after surgery
makes survival analysis reliable. In the histological subgroup
analysis, we found that the prognostic value of cyclin B1 seems to be
limited to the squamous cell subtype and has no predictive value among
patients with adenocarcinoma (Fig. 3 and C
).
This particular observation, together with the fact that cyclin B1
expression itself differs among histological subtypes, highlights the
biological differences among different subtypes of NSCLC. Different
abnormalities in oncogenes and tumor suppressor genes among
histological subtypes of NSCLC are well-known. Indeed,
K-ras mutations are much more common in
adenocarcinomas than in SCCs, whereas the p53 mutant immunophenotype is
more frequent in squamous carcinomas than in adenocarcinoma (17
, 18)
.
To determine whether overexpression of cyclin B1 in NSCLC simply reflects the increased cell proliferation, we analyzed Ki-67, a well-established marker of cell proliferation that is not phase specific in the cell cycle, in contiguous sections of the tumors. Consistent with previous reports, a weak correlation (0.30; P = 0.009) was found between the cyclin B1 index and Ki-67 score (9 , 10) . Although some of the previous studies have suggested that Ki-67 is a possible indicator of length of survival (12 , 19 , 20) , we failed to show any significant prognostic value for Ki-67 in our study population. The absence of prognostic value for Ki-67 remained even when survival analysis was performed using different cutoff levels published previously [i.e., 5%, 10%, or 20%; data not shown (9 , 20 , 21) ]. Nevertheless, the prognostic significance of Ki-67 in lung cancer is not yet firmly established because some studies suggest that a high Ki-67 expression level is predictive of poor survival (12 , 19 , 20) , whereas others did not demonstrate any effect (13 , 14 , 21) . Collectively, these observations suggest that high cyclin B1 expression in NSCLCs is not a mere consequence of cell proliferation, but rather an indicator of aberrant cell cycle progression at the G2-M-phase transition in cancer cells. Cyclin B1 also seems to play a pivotal role in the biological behavior of NSCLCs, particularly in SCC, and, in doing so, represents a potential new prognostic marker as well as a therapeutic target in NSCLC.
How overexpression of cyclin B1 participates in tumor progression remains to be established. Many authors suggest that the oncogenic role of cyclins is probably related to their unscheduled expression, namely, their expression throughout the cell cycle (22 , 23) . The unscheduled expression of cyclins in tumor cells could be the result of either impaired degradation or continued synthesis during the cell cycle. Regardless of the cause, the continuous presence of cyclins may cause activation of their respective partner kinases (cdks), which remain essentially invariable throughout the cell cycle. This, in turn, might lead to unscheduled phosphorylation of a variety of proteins, thus driving the cell through the cycle and bypassing the respective checkpoints. Recent findings that p53 controls a G2 checkpoint through down-regulation of cyclin B1 and that constitutive activation of cyclin B1 and associated cdc2 kinase can override this p53-mediated G2-M-phase arrest support this notion (24 , 25) .
In conclusion, this study has shown, using a homogeneous population of 77 patients with stage I NSCLC, that there is overexpression of cyclin B1 in lung tumors, particularly in SCC, and that such overexpression was associated with patients prognosis. More comprehensive studies involving greater numbers of patients are necessary to confirm these findings.
| Acknowledgments |
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| FOOTNOTES |
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1 Supported in part by American Cancer Society
Grant RPG-98-054 and National Cancer Institute Grant P01 CA74173 (to
L. M.), Fondation de France, AP-HP and Lilly Fondation Grant
(to J-C. S.), American Cancer Society-Clinical Oncology Career
Development Award 96-41 (to F. R. K.), National Cancer Institute
Grant U19 CA 68437 (to W. K. H.), Cancer Center Grant P30 CA 16620
(to the M. D. Anderson Cancer Center), and Tobacco Research Fund from
the State of Texas (M. D. Anderson Cancer Center). W. K. H. is an
American Cancer Society Clinical Research Professor. ![]()
2 To whom requests for reprints should be
addressed, at Molecular Biology Laboratory, Department of Thoracic/Head
and Neck Medical Oncology, The University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. Phone:
(713) 792-6363; Fax: (713) 796-8655; E-mail: lmao{at}notes.mdacc.tmc.edu ![]()
3 The abbreviations used are: NSCLC, non-small
cell lung cancer; SCC, squamous cell carcinoma; cdk, cyclin-dependent
kinase. ![]()
Received 3/14/00. Accepted 6/ 7/00.
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