title: SULF2 Expression Is a Potential Diagnostic and Prognostic Marker in Lung Cancer.
abstract: OBJECTIVE
  Lung cancer is one of the most deadly cancers; median survival from diagnosis is less than one year in those with advanced disease. Novel lung cancer biomarkers are desperately needed. In this study, we evaluated SULF2 expression by immunohistochemistry and its association with overall survival in a cohort of patients with non-small cell lung cancer (NSCLC). We also looked for the presence of SULF2 protein in plasma to evaluate its potential as an early detection biomarker for NSCLC.
  
  
  METHODS
  We identified patients who underwent surgical resection for pulmonary adenocarcinoma or squamous cell carcinoma at our institution. A section from each paraffin-embedded specimen was stained with a SULF2 antibody. A pathologist determined the percentage and intensity of tumor cell staining. Survival analysis was performed using a multivariate Cox proportional hazards model. Using a novel SULF2 ELISA assay, we analyzed plasma levels of SULF2 in a small cohort of healthy donors and patients with early stage NSCLC.
  
  
  RESULTS
  SULF2 staining was present in 82% of the lung cancer samples. Squamous cell carcinomas had a higher mean percentage of staining than adenocarcinomas (100% vs. 60%; p<0.0005). After adjusting for age, sex, race, histologic type, stage, and neoadjuvant therapy, there was a non-significant (31%; p = 0.65) increase in the risk of death for patients with adenocarcinoma with SULF2 staining in tumor cells. In contrast, there was a significant decrease in the risk of death (89%; p = 0.02) for patients with squamous cell carcinoma with SULF2 staining in tumor cells. SULF2 protein was present in plasma of patients with early stage NSCLC, and soluble SULF2 levels increased with age. Finally, plasma SULF2 levels were significantly elevated in early stage NSCLC patients, compared to healthy controls.
  
  
  CONCLUSIONS
  Tumor expression of SULF2 may affect prognosis in NSCLC, while blood SULF2 levels may have a significant role in the diagnosis of this fatal disease.
authors.affiliation: Thoracic Oncology Program, Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Lui
authors.affiliation: Thoracic Oncology Program, Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Yang
authors.affiliation: Department of Pathology, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Zante
authors.affiliation: Thoracic Oncology Program, Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Petra
authors.initials: P
authors.lastname: Buchanan
authors.affiliation: Thoracic Oncology Program, Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Jablons
authors.affiliation: Thoracic Oncology Program, Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Hassan
authors.initials: H
authors.lastname: Lemjabbar-Alaoui
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000235:genetics / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood* / Q000235:genetics / Q000473:pathology; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D013429:Sulfatases; D015238:Sulfotransferases / Q000097:blood* / Q000235:genetics; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D015238:Sulfotransferases; C470792:SULF2 protein, human; D013429:Sulfatases