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NANOG as an adverse predictive marker in advanced non–small cell lung cancer treated with platinum-based chemotherapy

Authors Chang B, Park MJ, Choi SI, In KH, Kim CH, Lee SH

Received 26 June 2017

Accepted for publication 11 August 2017

Published 19 September 2017 Volume 2017:10 Pages 4625—4633


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Tohru Yamada

Boksoon Chang,1 Myung Jae Park,1 Sue In Choi,2 Kwang Ho In,2 Chul Hwan Kim,3 Seung Hyeun Lee1

1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University School of Medicine, 2Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, 3Department of Pathology, College of Medicine, Korea University, Seoul, South Korea

Purpose: NANOG is a master transcription factor that regulates stem cell pluripotency and cellular reprograming. Increased NANOG expression has been associated with poor survival in several human malignancies. However, the clinical significance of NANOG overexpression in lung cancer has been scarcely evaluated. The aim of this study was to investigate whether NANOG levels are associated with clinical outcomes of patients with non–small cell lung cancer (NSCLC) who were treated with platinum-based chemotherapy.
Methods: NANOG levels were evaluated immunohistochemically using the histologic score (H-score) in tumor tissues from patients with advanced NSCLC who received platinum-based doublet treatment. We performed survival analyses according to the NANOG levels and evaluated the association between clinicopathological parameters and levels of NANOG.
Results: Multivariate analyses using 112 tumor specimens showed that high NANOG levels were independently associated with short progression-free survival (hazard ratio [HR] =3.09, 95% confidence interval [CI]: 2.01–4.76) and with short overall survival (HR =3.00, 95% CI: 1.98–4.54). Similar results were shown in the subgroup analyses for patients with adenocarcinoma and squamous cell carcinoma. NANOG expression was not associated with any clinicopathological parameter such as age, gender, smoking status, stage, differentiation, or histological subtypes.
Conclusion: NANOG overexpression was associated with poor response and short overall survival in patients with advanced NSCLC who were treated with platinum-based chemotherapy, suggesting that NANOG could be a potential adverse predictive marker in this setting.

Keywords: lung cancer, biomarker, cancer stem cell, NANOG, chemotherapy, platinum

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