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J Thorac Cardiovasc Surg 2009;137:615-621
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

CXCL12 and CXCR4 in adenocarcinoma of the lung: Association with metastasis and survival

^a Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
^c Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
^b Department of Pathology, University of Chicago, Chicago, Ill

Received for publication April 4, 2008; revisions received July 1, 2008; accepted for publication July 26, 2008.

^_* Address for reprints: Patrick L. Wagner, MD, Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, Starr-1036, 525 E 68th St, New York, NY 10021. (Email: plw9001{at}nyp.org).

Objectives: Although the chemokine CXCL12 and its receptor CXCR4 have been implicated in metastasis of non–small cell lung carcinoma, the prognostic significance of these molecules is poorly defined. This study aimed to determine whether expression of these molecules is associated with clinicopathologic features and disease-free survival in non–small cell lung carcinoma.

Methods: Immunohistochemical staining for CXCL12 and CXCR4 was performed on 154 primary non–small cell lung carcinomas. Staining intensity was compared with tumor histotype, TNM stage, and disease-free survival; correlation was assessed by using the Fisher's exact test, and Kaplan–Meier and Cox multivariate proportional hazards regression analysis.

Results: Intense CXCL12 immunostaining was associated with nodal metastasis, although no difference in survival was observed. The prognostic relevance of CXCR4 was dependent on its subcellular location: in univariate analysis intense nuclear staining was significantly associated with lower T classification and improved disease-free survival in patients with adenocarcinoma, whereas cytomembranous staining was associated with distant metastasis and decreased disease-free survival. On multivariate analysis, cytomembranous CXCR4 expression conferred a significantly worse disease-free survival (relative risk, 2.8; 95% confidence interval, 1.4–5.7; P = .004).

Conclusions: Cytomembranous expression of the chemokine receptor CXCR4 in adenocarcinoma of the lung is an independent risk factor associated with worse disease-free survival, whereas nuclear staining confers a survival benefit. These findings are consistent with a model in which CXCR4 promotes tumor cell proliferation and metastasis when present in the cytoplasm or cell membrane, whereas localization of this molecule in the nucleus prevents it from exerting these effects.

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