title: p21waf1/cip1 and transforming growth factor beta 1 protein expression correlate with survival in non-small cell lung cancer.
abstract: p21waf1/cip1 encodes a cyclin-dependent kinase inhibitor that is transcriptionally activated by the p53 tumor suppressor gene, transforming growth factor beta 1 (TGF-beta 1), AP2, and other pathways. Because p21waf1/cip1, p53, and TGF-beta 1 all regulate apoptosis and the cell cycle, we tested the hypothesis that their relative protein levels would correlate with biological features including the survival of non-small cell lung cancer (NSCLC) patients. We conducted an immunohistochemical analysis of p21waf1/cip1 and TGF-beta 1 and identified four patient groups with distinct survival outcomes. Concordant p21waf1/cip1 and TGF-beta 1 expression (i.e., either high p21waf1/cip1 and high TGF-beta 1 expression or low p21waf1/cip1 and low TGF-beta 1 expression) predicted 70% disease-free survival at 2000 days of follow-up. Discordant p21waf1/cip1 and TGF-beta 1 expression (i.e., either high p21waf1/cip1 and low TGF-beta 1 expression or low p21waf1/cip1 and high TGF-beta 1 expression) predicted 35% disease-free survival (P = 0.0003; log-rank test). These survival relationships were not attributable to differences in grade, stage, or p53 status. Although current models do not fully explain these complex interactions, most of these data fit a paradigm whereby TGF-beta 1 regulation determines NSCLC survival. In addition to the survival correlation, we found that high p21waf1/cip1 protein expression correlated with high tumor grade (P = 0.014). There is little evidence that p21waf1/cip1 protein levels accurately predict p53 mutation status in NSCLC; specifically, 20 of 48 (42%) tumors with p53 mutations contained high levels of p21waf1/cip1 protein. These findings indicate that p21waf1/cip1 immunohistochemical analysis may provide useful information concerning the biological properties of NSCLC.
authors.affiliation: National Cancer Institute, Bethesda, Maryland 20892, USA.
authors.forename: W P
authors.initials: WP
authors.lastname: Bennett
authors.forename: W S
authors.initials: WS
authors.lastname: el-Deiry
authors.forename: W L
authors.initials: WL
authors.lastname: Rush
authors.forename: D G
authors.initials: DG
authors.lastname: Guinee
authors.forename: A N
authors.initials: AN
authors.lastname: Freedman
authors.forename: N E
authors.initials: NE
authors.lastname: Caporaso
authors.forename: J A
authors.initials: JA
authors.lastname: Welsh
authors.forename: R T
authors.initials: RT
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: Borkowski
authors.forename: W D
authors.initials: WD
authors.lastname: Travis
authors.forename: M V
authors.initials: MV
authors.lastname: Fleming
authors.forename: V
authors.initials: V
authors.lastname: Trastek
authors.forename: P C
authors.initials: PC
authors.lastname: Pairolero
authors.forename: H D
authors.initials: HD
authors.lastname: Tazelaar
authors.forename: D
authors.initials: D
authors.lastname: Midthun
authors.forename: J R
authors.initials: JR
authors.lastname: Jett
authors.forename: L A
authors.initials: LA
authors.lastname: Liotta
authors.forename: C C
authors.initials: CC
authors.lastname: Harris
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D050759:Cyclin-Dependent Kinase Inhibitor p21; D016213:Cyclins / Q000032:analysis / Q000096:biosynthesis*; D018572:Disease-Free Survival; D004791:Enzyme Inhibitors / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D016158:Genes, p53; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009154:Mutation; D009367:Neoplasm Staging; D011379:Prognosis; D012727:Sex Characteristics; D016019:Survival Analysis; D013997:Time Factors; D016212:Transforming Growth Factor beta / Q000032:analysis / Q000096:biosynthesis*; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: C493956:CDKN1A protein, human; D050759:Cyclin-Dependent Kinase Inhibitor p21; D016213:Cyclins; D004791:Enzyme Inhibitors; D016212:Transforming Growth Factor beta; D016159:Tumor Suppressor Protein p53