Downregulation of N-Myc downstream-regulated gene 4 influences patient survival in gliomas.

N-Myc downstream-regulated gene 4 (NDRG4) plays important roles in cellular differentiation and neurite formation. It is required for cell cycle progression and survival in established glioblastoma cell lines and cancer stem cell-enriched cells. The aim of this study was to evaluate the correlation of NDRG4 expression with the clinicopathological features and prognosis in patients with gliomas. Immunohistochemistry and Western blot analysis were used to investigate the expression of NDRG4 protein, respectively, in 128 patients with gliomas. Immunohistochemistry showed that NDRG4 expression was significantly reduced in glioma relative to nonneoplastic brain tissues (P = 0.008), and that its expression decreased with increasing glioma grade. These results were in line with the results of Western blot analysis. In addition, a non-parametric analysis revealed that the reduced NDRG4 expression was significantly correlated with a low Karnofsky performance score (P = 0.01), frequent intra-tumor necrosis (P = 0.03), and poor overall survival (P = 0.01). Furthermore, multivariate analysis showed that NDRG4 expression (P = 0.03) and intra-tumor necrosis (P = 0.03) were two important independent prognostic factors identified by the Cox proportional hazard model. Our results provide convincing evidence for the first time that the expression of NDRG4 is downregulated in human gliomas. The glioma patients with lower NDRG4 expression have a poor prognosis.