title: Relationship of hypoxia-inducible factor 1alpha and p21WAF1/CIP1 expression to cell apoptosis and clinical outcome in patients with gastric cancer.
abstract: BACKGROUND
  Hypoxia-inducible factor-1alpha (HIF-1alpha) plays an essential role in oxygen homeostasis. The expression of HIF-1alpha-inducible genes is associated with tumor progression. p21 mediates cell cycle arrest and is one of the downstream genes targeted by HIF-1.
  
  
  METHODS
  We examined the relationship between HIF-1alpha and p21 expression, apoptosis and tumor progression using tissue specimens obtained surgically from 126 patients with gastric cancer.
  
  
  RESULTS
  Immunohistochemical analysis indicated that loss of p21 expression correlated positively with patient age and tumor size. Lymph node metastasis was significantly more frequent in tumors with loss of p21 expression (P = 0.022). HIF-1alpha-positive/p21-negative tumors had a lower apoptotic index than any other tumor samples, and patients with HIF-1alpha-positive/p21-negative tumors also had a significantly poorer prognosis than the other patient populations.
  
  
  CONCLUSIONS
  These results suggest that loss of HIF-1alpha-dependent p21 expression results in decreased apoptosis, increased cell survival and more aggressive tumors.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan. mizoken@xc4.so-net.ne.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Mizokami
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Shinya
authors.initials: S
authors.lastname: Oda
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara