Research Article Overexpression of FRAT1 Is Associated with Malignant Phenotype and Poor Prognosis in Human Gliomas
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Hindawi Publishing Corporation Disease Markers Volume 2015, Article ID 289750, 8 pages http://dx.doi.org/10.1155/2015/289750 Research Article Overexpression of FRAT1 Is Associated with Malignant Phenotype and Poor Prognosis in Human Gliomas Geng Guo,1,2 Cheng-liang Zhong,3,4 Yang Liu,5 Xing-gang Mao,6 Zheng Zhang,7 Ji Jin,8 Jing Liu,2 Liu Yang,9 Jin-ming Mao,9 Yu-hong Guo,2 and Yuan-li Zhao1 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China 2DepartmentofNeurosurgery,TheFirstHospital,ShanxiMedicalUniversity,Taiyuan,Shanxi030001,China 3GCP Center, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300192, China 4Postdoctoral Programme, China Academy of Chinese Medical Sciences, Beijing 100700, China 5Department of Neurosurgery, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China 6Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi 710032, China 7Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China 8Shanxi Medical University, Taiyuan, Shanxi 030001, China 9Department of Neurology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, China Correspondence should be addressed to Geng Guo; [email protected] and Yuan-li Zhao; [email protected] Received 23 January 2015; Accepted 20 March 2015 Academic Editor: Vincent Sapin Copyright © 2015 Geng Guo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Glioma is the most common malignancy of the central nervous system. Approximately 40 percent of intracranial tumors are diagnosed as gliomas. Difficulties in treatment are associated closely with the malignant phenotype, which is characterized by excessive proliferation, relentless invasion, and angiogenesis. Although the comprehensive treatment level of brain glioma is continuously progressing, the outcome of this malignancy has not been improved drastically. Therefore, the identification of new biomarkers for diagnosis and therapy of this malignancy is of significant scientific and clinical value. FRAT1 is a positive regulator of the Wnt/-catenin signaling pathway and is overexpressed in many human tumors. In the present study, we investigated the expression status of FRAT1 in 68 patients with human gliomas and its correlation with the pathologic grade, proliferation, invasion, angiogenesis, and prognostic significance. These findings suggest that FRAT1 may be an important factor in the tumorigenesis and progression of glioma and could be explored as a potential biomarker for pathological diagnosis, an indicator for prognosis, and a target for biological therapy of malignancy. 1. Introduction despite having undergone surgical treatment combined with radiotherapy and chemotherapy [2]. Therefore, the identifi- Glioma is the most common malignancy of the central cation of new biomarkers for diagnosis and therapy of this nervous system. Approximately 40 percent of intracranial malignancy is of significant scientific and clinical value. tumors are diagnosed as gliomas [1]. Difficulties in treatment The FRAT1 (frequently rearranged in advanced T-cell areassociatedcloselywiththemalignantphenotype,whichis lymphomas-1) gene, located on human chromosome 10q24.1 characterized by excessive proliferation, relentless invasion, [3], encodes a 29 kDa protein comprising 279 amino acids. and angiogenesis. Although the comprehensive treatment FRAT1isapositiveregulatoroftheWnt/-catenin signaling level of brain glioma is continuously progressing, the out- pathway [4–6] and is overexpressed in many human tumors come of this malignancy has not been improved drastically. [7–11]. Recently, we demonstrated that FRAT1 expression For example, patients with the most malignant histopatho- is elevated in gliomas [12, 13] and that its expression is logic subtype, glioblastoma (GBM), carry the worst progno- correlated with pathologic grade, proliferation, and apoptosis sis, with a median survival period of less than 12 months, in astrocytomas [13]. The expression of FRAT1 is considered 2 Disease Markers to be crucial for the maintenance of the malignant cellular phenotype. However, little is known about the contribution of FRAT1 expression to the prognosis of glioma. In the present study, we investigated the expression status of FRAT1 in 68 patients with human gliomas and its correlation with the pathologic grade, proliferation, invasion, angiogenesis, and prognostic significance. These results may have important implications in both predicting the clinical prognosis and understanding the biology of these tumors. 2. Materials and Methods 2.1. Tumor Specimens. Sixty-eight patients with gliomas were included in this retrospective study. All of the cases were surgically treated at the Neurosurgical Department of the Xijing Hospital affiliated to the Fourth Military Medical University from June 2007 to August 2009. The patients included 35 males and 29 females ranging in age from 6 to 76 years (45.6 ± 17.7,mean± standard deviation (SD)). All tumor tissues were obtained from the initial surgery prior to chemotherapy or radiation therapy. The extents of resection (gross total (greater than 90% resected) or subtotal (60% to 90% resected)) were documented on the basis of the surgeon’s intraoperative impression with postoperative radiographic confirmation of the absence or presence of residual disease. The extent of resection was greater than 60% for all patients in the study. Histologic subtypes and pathologic grades of tumors were quantified according to the revised World Health Organization (WHO) criteria for the central nervous system [1] as follows: 10 cases with Grade I, all pilocytic gliomas; 19 cases with Grade II, including 16 diffuse gliomas, 2 oligodendrogliomas, and 1 protoplasmic glioma; 16 cases with Grade III, including 12 anaplastic gliomas and 4 anaplastic oligodendrogliomas; and 23 cases with Grade IV, all glioblastomas. The pathologic grades of all samples were confirmed independently by two pathologists. Five samples of slightly impaired brain tissue fragments from volunteers with cerebral trauma were used as control. Twenty-three patients with glioblastoma were treated with surgery, radio- therapy, and adjuvant chemotherapy. They were followed up every 2 months for at least 24 months posttreatment. This study was approved by the Institutional Review Board of the Xijing Hospital of the Fourth Military Medical University, Xi’an, China. All participants provided written informed 4 Disease Markers Table 1: Measurements of FRAT1 IRS, Pi, Ii, and MVD in gliomas. Glioma tissues FRAT1 IRS Pi % Ii % MVD Grade I 10 1.30 ± 1.77 12.62 ± 11.24 9.18 ± 12.03 30.36 ± 11.69 Grade II 19 2.63 ± 2.91 23.66 ± 13.69 19.84 ± 15.66 51.08 ± 15.27 Grade III 16 4.50 ± 3.76 35.19 ± 16.08 26.80 ± 18.05 73.81 ± 24.52 Grade IV 23 6.70 ± 3.89 48.23 ± 21.05 39.91 ± 19.12 90.14 ± 29.28 Total 68 4.25 ± 3.86a 33.06 ± 20.93a 26.70 ± 19.93a 66.59 ± 31.05a a < 0.001 as compared among Grades I to IV of brain gliomas (by ANOVA). IRS, immunoreactivity score; Pi, proliferative index; Ii, invasive index; MVD, microvessel density. Table 2: IRS, Pi, Ii, and MVD in FRAT1-positive and FRAT1-negative groups of gliomas. All gliomas % (range) FRAT1-positive % FRAT1-negative % Pi 33.06 ± 20.93 (0.8 to 85.3) 45.59 ± 16.78% 14.03 ± 8.51% = 10.21 < 0.001 Ii 26.70 ± 19.3 (0 to 69.0) 36.72 ± 18.29% 11.49 ± 10.51% = 7.21 < 0.001 MVD 66.59 ± 31.05 (14 to 145) 75.10 ± 31.58 53.68 ± 25.75 = 2.94 = 0.0045 Pi, proliferative index; Ii, invasive index; MVD, microvessel density. Grade I Grade II Grade III Grade IV Disease Markers 5 100 12 11 90 10 80 9 70 8 60 7 6 50 5 40 FRAT1 IRS FRAT1 4 30 3 Proliferative index (%) Proliferative 20 2 1 10 0 0 IIIIIIIV IIIIIIIV Pathologic grade Pathologic grade (a) (b) 100 150 140 90 130 80 120 110 70 100 60 90 80 50 70 40 60 50 30 Invasive index (%) Invasive Microvessel density Microvessel 40 20 30 20 10 10 0 0 IIIIIIIV IIIIIIIV Pathologic grade Pathologic grade (c) (d) 6 Disease Markers 100 100 90 90 80 80 70 70 60 60 50 50 40 40 30 30 Invasive index (%) Invasive Proliferative index (%) Proliferative 20 20 10 10 0 0 0 123456 7 8 9 10 11 12 0 123456 7 8 9 10 11 12 FRAT1 IRS FRAT1 IRS (a) (b) 150 140 130 120 110 100 90 80 70 60 50 40 Microvessel density Microvessel 30 20 10 0 0 123456 7 8 9 10 11 12 FRAT1 IRS (c) Figure 3: Correlation of the FRAT1 IRS with other malignant activity scores. Scatterplots demonstrate the correlation of the FRAT1 IRS with the Pi, Ii, and MVD in human glioma. A trend line provided in each plot r Disease Markers 7 1.00 approved the final paper. Geng Guo, Cheng-liang Zhong, and Yang Liu contributed equally to this work. 0.75 Acknowledgments 0.50 The authors appreciate Dr. Li-na Wu (Department of Pathol- ogy, The First Hospital, Shanxi Medical University) and Dr. Ya-qin Li (Department of Pathology, Shanxi Dayi Hospital) 0.25 for confirming the pathological diagnosis of all the samples used in this research and helping to perform microscopic Estimated survival probability Estimated analysis.TheyalsothankMeng-naChen,TingLiu,TingLv, 0.00 Xin Lv, and Xin Rong for preparing for this research. This 0 020406081012141618202224 work was supported by the National Natural Science Foun- dation of China (no. 81201991), the Basic Research Program Observation points (month) of Shanxi Province of China (no. 2012021035-5), the Program Survival curve for the Outstanding Innovative Teams of Higher Learning FRAT1: negative Institutions of Shanxi, and the Scientific Research Subject of FRAT1: positive Shanxi Provincial Health Department (no. 201301066). Figure 4: Correlation of FRAT1 positivity with outcome in GBM. Kaplan-Meier survival analysis of GBM patients with FRAT1- References positive or -negative expression.