title: LEF-1 and TCF4 expression correlate inversely with survival in colorectal cancer.
abstract: BACKGROUND
  Most colorectal carcinomas are driven by an activation of the canonical Wnt signalling pathway, which promotes the expression of multiple target genes mediating proliferation inavasion and invasion. Upon activation of the Wnt signalling pathway its key player β-catenin translocates from the cytoplasm to the nucleus and binds to members of the T-cell factor (TCF)/lymphoid enhancer factor (LEF-1) family namely LEF-1 and TCF4 which are central mediators of transcription. In this study we investigated the expression of β-Catenin, LEF1 and TCF4 in colorectal carcinomas and their prognostic significance.
  
  
  METHODS
  Immunohistochemical analyses of LEF-1, TCF4 and nuclear β-Catenin were done using a tissue microarray with 214 colorectal cancer specimens. The expression patterns were compared with each other and the results were correlated with clinicopathologic variables and overall survival in univariate and multivariate analysis.
  
  
  RESULTS
  LEF-1 expression was found in 56 (26%) and TCF4 expression in 99 (46%) of colorectal carcinomas and both were heterogeneously distributed throughout the tumours. Comparing LEF-1, TCF4 and β-catenin expression patterns we found no correlation. In univariate analysis, TCF4 expression turned out to be a negative prognostic factor being associated with shorter overall survival (p = 0.020), whereas LEF-1 expression as well as a LEF-1/TCF4 ratio were positive prognostic factors and correlated with longer overall survival (p = 0.015 respectively p = 0.001). In multivariate analysis, LEF-1 and TCF4 expression were confirmed to be independent predictors of longer respectively shorter overall survival, when considered together with tumour stage, gender and age (risk ratio for LEF-1: 2.66; p = 0.027 risk ratio for TCF4: 2.18; p = 0.014).
  
  
  CONCLUSIONS
  This study demonstrates different prognostic values of LEF-1 and TCF4 expression in colorectal cancer patients indicating different regulation of these transcription mediators during tumour progression. Moreover both factors may serve as new potential predictive markers in low stage colon cancer cases in advance.
authors.affiliation: Department of Pathology, Ludwig-Maximilians-Universität (LMU), Thalkirchnerstr, 36, 80337, Munich, Germany. Lydia.Kriegl@med.uni-muenchen.de
authors.forename: Lydia
authors.initials: L
authors.lastname: Kriegl
authors.forename: David
authors.initials: D
authors.lastname: Horst
authors.forename: Jana A
authors.initials: JA
authors.lastname: Reiche
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
authors.forename: Thomas
authors.initials: T
authors.lastname: Kirchner
authors.forename: Andreas
authors.initials: A
authors.lastname: Jung
mesh_terms: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors / Q000378:metabolism*; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D051821:Lymphoid Enhancer-Binding Factor 1 / Q000378:metabolism*; D016019:Survival Analysis; D000073940:Transcription Factor 4; D014157:Transcription Factors / Q000378:metabolism*
chemical_list: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors; C497573:LEF1 protein, human; D051821:Lymphoid Enhancer-Binding Factor 1; C532096:TCF4 protein, human; D000073940:Transcription Factor 4; D014157:Transcription Factors