Bencivenga Maria, Torroni Lorena, Dal Cero Mariagiulia, Quinzii Alberto, Zecchetto Camilla, Merz Valeria, Casalino Simona, Taus Francesco, Pietrobono Silvia, Mangiameli Domenico, Filippini Federica, Alloggio Mariella, Castelli Claudia, Iglesias Mar, Pera Manuel, Melisi Davide
General and Upper GI Surgery, Department of Surgery, Verona University, 37126 Verona, Italy.
Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy.
J Pers Med. 2023 Aug 24;13(9):1294. doi: 10.3390/jpm13091294.
Poorly cohesive (PC) gastric cancer (GC) is extremely aggressive in progression, and there is an urgent need to identify the molecular pathways involved. We hypothesized the essential role of the RhoA-YAP axis in these mechanisms. The present observational multicenter retrospective study included 133 patients with PC GC treated at two dedicated European surgical centers between 2004 and 2014. YAP nuclear localization was measured by immunohistochemical (IHC) analysis of tissue biopsies. The complete absence of nuclear reactivity was coded as negative expression; we considered "any positive" as low nuclear expression (>0% but <10% of cells) and high nuclear expression (≥10% of cells). Women represented about half of the present series (52%), and the median age was 64 years (p25-p75 range: 53-75). Neoadjuvant and adjuvant treatments were administered to 10% and 54% of the cases, respectively. Extended systemic lymphadenectomy (D2) was the most common (54%). In nearly all cases, the number of retrieved nodes was ≥15, i.e., adequate for tumor staging (94%). An R0 resection was achieved in 80% of the cases. Most patients were pathological T stage 3 and 4 (pT3/pT4 = 79.0%) and pathological N stage 2, 3a, and 3b (pN2/pN3a/pN3b = 47.0%) at the pathological examination. Twenty patients (15%) presented distant metastases. Five-year overall survival (OS) was significantly higher ( = 0.029) in patients with negative YAP (46%, 95% CI 31.1-60.0%) than in the other patients (27%, 17.5-38.1%). Moreover, when controlling for sex, age, pT, pN, and percentage of signet ring cells in the multivariable analysis, YAP expression was a significant predictor of OS (HR 2.03, 95% CI: 1.18-3.51, = 0.011). Our results provide new insights into the role of the YAP signaling cascade, as its activation was associated with a worse prognosis in PC GC.
低黏附性(PC)胃癌(GC)进展极为迅速,迫切需要明确其中涉及的分子途径。我们推测RhoA-YAP轴在这些机制中起关键作用。本观察性多中心回顾性研究纳入了2004年至2014年间在两个欧洲专门的外科中心接受治疗的133例PC GC患者。通过组织活检的免疫组织化学(IHC)分析来检测YAP核定位。完全没有核反应性被编码为阴性表达;我们将“任何阳性”视为低核表达(>0%但<10%的细胞)和高核表达(≥10%的细胞)。女性约占本系列患者的一半(52%),中位年龄为64岁(第25至75百分位数范围:53 - 75岁)。分别有10%和54%的病例接受了新辅助治疗和辅助治疗。扩大的系统性淋巴结清扫术(D2)最为常见(54%)。几乎在所有病例中,回收的淋巴结数量≥15个,即足以进行肿瘤分期(94%)。80%的病例实现了R0切除。在病理检查中,大多数患者为病理T3和T4期(pT3/pT4 = 79.0%)以及病理N2、3a和3b期(pN2/pN3a/pN3b = 47.0%)。20例患者(15%)出现远处转移。YAP阴性患者的五年总生存率(OS)显著更高( = 0.029)(46%,95%置信区间31.1 - 60.0%)高于其他患者(27%,17.5 - 38.1%)。此外,在多变量分析中控制性别、年龄、pT、pN和印戒细胞百分比后,YAP表达是OS的显著预测因子(风险比2.03,95%置信区间:1.18 - 3.51, = 0.011)。我们的结果为YAP信号级联的作用提供了新的见解,因为其激活与PC GC的预后较差相关。
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