1. Transcriptome-wide studies of merkel cell carcinoma and validation of intratumoral CD8+ lymphocyte invasion as an independent predictor of survival
- Author
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Denise A. Galloway, Renee Thibodeau, Michele A. Cleary, Janell Schelter, David M. Koelle, Margaret M. Madeleine, Bianca D. Lemos, Mary L. Disis, William T. Simonson, Jayasri G. Iyer, Zsolt B. Argenyi, Andrew Tegeder, Paul Nghiem, Kelly G. Paulson, J. Helen Leonard, David Schrama, Shinichi Koba, Juergen C. Becker, and David R. Byrd
- Subjects
Male ,Cancer Research ,Pathology ,Skin Neoplasms ,Time Factors ,Merkel cell polyomavirus ,Kaplan-Meier Estimate ,CD8-Positive T-Lymphocytes ,Metastasis ,Risk Factors ,Cluster Analysis ,Aged, 80 and over ,Immune response gene ,Paraffin Embedding ,biology ,Merkel cell carcinoma ,Reverse Transcriptase Polymerase Chain Reaction ,Middle Aged ,Prognosis ,Immunohistochemistry ,Gene Expression Regulation, Neoplastic ,Survival Rate ,Oncology ,Austria ,Biomarker (medicine) ,Female ,Queensland ,Adult ,Washington ,medicine.medical_specialty ,Risk Assessment ,Article ,Lymphocytes, Tumor-Infiltrating ,Original Reports ,medicine ,Humans ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,business.industry ,Gene Expression Profiling ,Cancer ,Reproducibility of Results ,medicine.disease ,biology.organism_classification ,Gene expression profiling ,Carcinoma, Merkel Cell ,Cancer research ,Skin cancer ,business - Abstract
Purpose Merkel cell carcinoma (MCC) is a polyomavirus-associated skin cancer that is frequently lethal and lacks established prognostic biomarkers. This study sought to identify biomarkers that improve prognostic accuracy and provide insight into MCC biology. Patients and Methods Gene expression profiles of 35 MCC tumors were clustered based on prognosis. The cluster of genes overexpressed in good-prognosis tumors was tested for biologic process enrichment. Relevant mRNA expression differences were confirmed by quantitative polymerase chain reaction and immunohistochemistry. An independent set of 146 nonoverlapping MCC tumors (median follow-up, 25 months among 116 living patients) was employed for biomarker validation. Univariate and multivariate Cox regression analyses were performed. Results Immune response gene signatures were prominent in patients with good prognoses. In particular, genes associated with cytotoxic CD8+ lymphocytes were overexpressed in tumors from patients with favorable prognoses. In the independent validation set, cases with robust intratumoral CD8+ lymphocyte infiltration had improved outcomes (100% MCC-specific survival, n = 26) compared with instances characterized by sparse infiltration (60% survival, n = 120). Only stage and intratumoral CD8 infiltration (but not age, sex, or CD8+ lymphocytes localized to the tumor-stroma interface) were significant in both univariate and multivariate Cox regression analyses. Notably, traditional histologic identification of tumor-infiltrating lymphocytes was not a significant independent predictor of survival. Conclusion Intratumoral CD8+ lymphocyte infiltration can be readily assessed on paraffin-embedded tissue, is independently associated with improved MCC-specific survival, and therefore, may provide prognostic information that enhances established MCC staging protocols.
- Published
- 2011