title: NM23 protein expression in colorectal carcinoma using TMA (tissue microarray): association with metastases and survival.
abstract: BACKGROUND
  NM23, a metastasis suppressor gene, may be associated with prognosis in patients with colorectal carcinoma.
  
  
  OBJECTIVE
  To analyze NM23 expression and its association with the presence of lymph node and liver metastases and survival in patients operated on for colorectal carcinoma.
  
  
  METHODS
  One hundred thirty patients operated on for colorectal carcinoma were investigated. Tissue microarray blocks containing neoplastic tissue and tumor-adjacent non-neoplastic mucosa were obtained and analyzed by immunohistochemical staining using a monoclonal anti-NM23 antibody. Immunohistochemical expression was assessed using a semiquantitative scoring method, counting the percentage of stained cells. The results were compared regarding morphological and histological characteristics of the colorectal carcinoma, presence of lymph node and liver metastases, tumor staging, and patient survival. Statistical analysis was performed using the Mann-Whitney test, the Kruskal-Wallis test and Fisher's exact test. Survival analysis was performed using the Kaplan-Meier method and the log-rank test.
  
  
  RESULTS
  NM23 expression was higher in colorectal carcinoma tissue than in adjacent non-neoplastic mucosa (P<0.0001). NM23 protein expression did not correlate with degree of cell differentiation (P = 0.57), vascular invasion (P = 0.85), lymphatic invasion (P = 0.41), perineural infiltration (P = 0.46), staging (P = 0.19), lymph node metastases (P = 0.08), or liver metastases (P = 0.59). Disease-free survival showed significant association (P = 0.01) with the intensity of NM23 protein immunohistochemical expression in colorectal carcinoma tissue, whereas overall survival showed no association with NM23 protein expression (P = 0.13).
  
  
  CONCLUSIONS
  NM23 protein expression was higher in neoplastic colorectal carcinoma tissue than in adjacent non-neoplastic mucosa, showing no correlation with morphological aspects, presence of lymph node or liver metastases, colorectal carcinoma staging, or overall survival. Disease-free survival was higher in patients with increased NM23 expression.
authors.affiliation: Departments of Surgery, São Paulo Federal University, Brazil.
authors.forename: Levindo Alves de
authors.initials: LA
authors.lastname: Oliveira
authors.forename: Ricardo
authors.initials: R
authors.lastname: Artigiani-Neto
authors.forename: Daniel Reis
authors.initials: DR
authors.lastname: Waisberg
authors.forename: Luis Cesar
authors.initials: LC
authors.lastname: Fernandes
authors.forename: Flávio de Oliveira
authors.initials: Fde O
authors.lastname: Lima
authors.forename: Jaques
authors.initials: J
authors.lastname: Waisberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D002277:Carcinoma / Q000737:chemistry / Q000556:secondary*; D015179:Colorectal Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000737:chemistry; D008113:Liver Neoplasms / Q000556:secondary*; D008198:Lymph Nodes / Q000201:enzymology; D008207:Lymphatic Metastasis; D008297:Male; D046228:Microarray Analysis; D008875:Middle Aged; D054778:NM23 Nucleoside Diphosphate Kinases / Q000032:analysis*; D016019:Survival Analysis; D046888:Tissue Array Analysis
chemical_list: D014408:Biomarkers, Tumor; D054778:NM23 Nucleoside Diphosphate Kinases