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Prognostic Significance of FAM3C in Esophageal Squamous Cell Carcinoma

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Prognostic Significance of FAM3C in Esophageal Squamous Cell Carcinoma Zhu et al. Diagnostic Pathology (2015) 10:192 DOI 10.1186/s13000-015-0424-8 RESEARCH Open Access Prognostic significance of FAM3C in esophageal squamous cell carcinoma Ying-Hui Zhu1†, Baozhu Zhang1†, Mengqing Li1, Pinzhu Huang5, Jian Sun1, Jianhua Fu1,3,4* and Xin-Yuan Guan1,2* Abstract Background: Family with sequence similarity 3, member C (FAM3C) has been identified as a novel regulator in epithelial-mesenchymal transition (EMT) and metastatic progression. However, the role of FAM3C in esophageal squamous cell carcinoma (ESCC) remains unexplored. The purpose of present study is to illustrate the role of FAM3C in predicting outcomes of patients with ESCC. Methods: FAM3C expression was measured in ESCC tissues and the matched adjacent nontumorous tissues by quantitative real-time RT-PCR and Western blot analysis. The relationship between FAM3C expression and prognosis of ESCC patients was further evaluated by univariate and multivariate regression analyses. Univariate and multivariate analyses of the prognostic factors were performed using Cox proportional hazards model. Results: The FAM3C mRNA expression was remarkably upregulated in ESCC compared with their nontumor counterparts (P < 0.001). In addition, high expression of FAM3C was significantly associated with pT stage (P = 0.014) , pN stage (P = 0.026) and TNM stage (P = 0.003). Kaplan-Meier analysis showed that the 7-year overall survival rate in the group with high expression of FAM3C was poorer than that in low expression group (32.0 versus 70.9 %; P <0.001). Univariate and multivariate analyses demonstrated that FAM3C was an independent risk factor for overall survival. Moreover, Stratified analysis revealed that FAM3C expression could differentiate the prognosis of patients in early clinical stage (TNM stage I-II). Conclusions: FAM3C expression was dramatically increased in ESCC and might serve as a valuable prognostic indicator for ESCC patients after surgery. Keywords: FAM3C, ESCC, Prognosis, EMT Background and heterogeneous disease which is driven by a series of Esophageal cancer (EC) is one of the most common ma- genetic and epigenetic alterations. Therefore, it is impera- lignancies and ranked as the sixth leading cause of cancer- tive to search for sensitive and specific biologic markers related mortality worldwide [1, 2]. Esophageal squamous for prevention, screening, diagnosis and development of cell carcinoma (ESCC), the most prevalent histological specific therapies. subtype of EC, is characterized by its remarkable geo- To obtain a clear picture of genetic alterations occurring graphic distribution, and predominates in Northern Iran, in ESCC patients, our group performed high-throughput South Africa, and Northern China, especially in Henan transcriptome sequencing (RNA-Seq) on three matched province [3, 4]. Despite the recent advances in diagnosis pairs of ESCC and the adjacent nontumorous tissues to and treatment, the prognosis of ESCC patients remains identify differentially expressed genes. Family with se- dismal and the 5-year overall survival rate is ranging from quence similarity 3, member C (FAM3C), or interleukin- 10 to 41 % [5–7]. ESCC has been viewed as a complex like epithelial-mesenchymal transition inducer (ILEI) brought up our attention due to its significantly upregu- * Correspondence: [email protected]; [email protected] lated expression in ESCC specimens. It belongs to the †Equal contributors family with sequence similarity 3 (FAM3) superfamily and 1 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in encodes a secreted protein with a GG domain. There are South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China four members in this family, FAM3A, FAM3B, FAM3C, Full list of author information is available at the end of the article © 2015 Zhu et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Zhu et al. Diagnostic Pathology (2015) 10:192 Page 2 of 7 and FAM3D, each encoding a protein (224–235 amino a SYBR Green PCR Kit (Applied Biosystems) and acids) with a hydrophobic leader sequence [8]. FAM3C LightCycler480 384-well PCR system (Roche Diagnostics). was initially identified as a candidate gene for autosomal The GAPDH was used as an internal control for FAM3C, recessive non-syndromic hearing loss locus 17 (DFNB17) E-cadherin and vimentin. Primers for FAM3C are 5′- [9]. Recent works have revealed that FAM3C was a novel CCTTGGCAAATGGAAAAACAGG-3′ (forward) and 5′- regulator of epithelial-mesenchymal transition (EMT) and CCCAAATCAGCAATGAGCCG-3′ (reverse). Primers for metastatic progression [10, 11]. In addition, overexpres- E-cadherin are 5′-TGAAGGTGACAGAGCCTCTGGAT- sion of FAM3C was detected in pancreatic cancer and 3′ (forward) and 5′-TGGGTGAATTCGGGCTTGTT-3′ colorectal cancer [12, 13], suggesting important roles of (reverse). Primers for vimentin are 5′-CCTTGAACGCAA FAM3C in the metastasis and progression of cancer. How- AGTGGAATC-3′ (forward) and 5′-GACATGCTGTTC ever, the expression pattern and clinical significance of CTGAATCTGAG-3′ (reverse). Primers for GAPDH are FAM3C in ESCC has not been explored. 5′-ACTTCAACAGCGACACCCACTC-3′ (forward) and Here we measured the expression level of FAM3C in 5′-TACCAGGAAATGAGCTTGACAAAG-3′ (reverse). ESCC and matched adjacent nontumorous specimens, The value of relative expression for each sample was aver- and further explored its clinicopathological significance aged and compared using the Ct method. ΔΔCt(sample) = and prognostic value in ESCC. ΔCt(sample) - ΔCt(calibrator), ΔCt(sample) = Ct(sample) of target gene - Ct(sample) of GAPDH; ΔCt(calibrator) = Methods Ct(calibrator) of target gene - Ct(calibrator) of GAPDH; Patients and tissue samples calibrator was defined as the pooled samples from 40 adja- One hundred seven primary ESCC tumor and 40 paired cent nontumorous tissues. The fold changes in mRNAs –ΔΔ adjacent nontumorous tissue samples were collected im- were calculated by the equation 2 Ct. mediately after surgery resection at Sun Yat-sen Univer- sity Cancer Center between March 2002 and October Western blot analysis 2008. The inclusion criteria were as follows: (a) definitive Frozen tissue specimens were ground under liquid ESCC diagnosis by pathology based on WHO criteria; nitrogen. Total protein was extracted with lysis buffer (b) complete surgical resection, defined as complete for one hour on ice. Equal amounts of protein were sep- resection of all tumor nodules with the cut surface being arated by 15 % SDS-PAGE and electrophoretically trans- free of cancer by histologic examination; (c) no neoadju- ferred to polyvinylidene difluoride membranes (Roche) vant or adjuvant treatment before surgery; (d) complete using a mini trans-blot apparatus (Bio-Rad Laboratories). clinicopathologic and follow-up data. Ethical approval Membranes were blocked with TBS-0.1 % Tween 20 for this study was granted by the Medical Ethics Com- containing 5 % nonfat dry milk for one hour at room mittee of Sun Yat-sen University Cancer Center. All temperature and incubated with rabbit polyclonal anti- patients signed informed consent. Tumor differentiation body against FAM3C (1:1,000; Proteintech) or GAPDH (G1, well differentiated; G2, moderately differentiated; G3, (1:1,000; Abgent) at 4 °C overnight. Membranes were then poorly differentiated), depth of tumor invasion (pT stage) washed three times with TBS-0.1 % Tween 20 and incu- and lymph node metastasis (pN stage) were determined bated with horseradish peroxidase (HRP) –conjugated by pathologic examination. Tumor staging was deter- goat anti-rabbit IgG antibody (Cell Signaling Technology) mined according to the seventh edition tumor-node- at a 1:3,000 dilution for one hour at room temperature. metastasis (TNM) classification of the American Joint Blots were developed using a Luminata Crescendo Committee on Cancer [14]. Western HRP substrate (Millipore). GAPDH was used as a loading control. Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) Statistical analysis All fresh tumorous and nontumorous tissue samples were All statistical analyses were performed using the Statis- taken from regions which macroscopically judged to be tical Package for the Social Sciences (SPSS) version 16.0 neoplastic and normal, respectively. Both of them were (SPSS Inc, Chicago, IL). Paired two-tailed student’s t test immediately stored at dry ice after resection and then fro- was used to compare the expression of FAM3C in zen at −80 °C. Total RNA was extracted from clinical sam- primary ESCC tumors and their corresponding adjacent ples using TRIzol reagent (Invitrogen), and was reverse- nontumorous tissues. The correlation between FAM3C transcribed using an Advantage RT-for-PCR Kit (Clontech expression and clinicopathological parameters was Laboratories) according to the manufacturer’sinstruc- assessed by chi-square test or Fisher’s exact test. Overall tions. qRT-PCR was performed to detect mRNA levels of survival (OS) was defined as the interval from curative the corresponding
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