The purpose of this study was to evaluate expression and prognostic impact of Nanog, Oct4, Sox2, proliferation cell nuclear antigen (PCNA), Ki67 and E-cadherin in patients with gastric cancer (GC) by immunohistochemistry. A total of 69 patients were recruited who underwent gastrectomy between 2008 and 2009. We found that expression levels of Nanog, Oct4, Sox2, PCNA, Ki67 and E-cadherin were 26.1, 53.6, 49.3, 52.2, 60.9 and 60.9 %, respectively. Co-expression of more than any two proteins (defined as high-risk group) was detected in 43 of 69 (62.3 %) patients with GC. Only positive expression of Oct4 had relationship with lymphatic invasion (p = 0.013), and positive expression of Ki67 was correlated with T classification (p = 0.011). Furthermore, positive expression of Oct4 (p = 0.043), PCNA (p = 0.035) and Ki67 (p = 0.023) was significantly associated with poor 3-year disease-free survival (DFS). The same result was detected in patients with E-cadherin reduced expression (p = 0.022). But only PCNA positive expression predicted poor overall survival (p = 0.042) in univariate analysis. In addition, 3-year DFS was 20 % in high-risk group and 71 % in low-risk group. The same tendency was found between OS and co-expression of proteins. There was a remarkable difference between DFS or OS and co-expression of more than two proteins (p = 0.000). Multivariate analysis showed that E-cadherin and co-expression were independent prognostic factors of 3-year diseases-free survival. But only co-expression of more than two markers dramatically affected the survival of GC patients. These findings provide evidence that combined evaluation of Nanog, Oct4, Sox2, PCNA, Ki67 and E-cadherin may be a more powerful prognostic factor to predict relapse and distant metastasis for patients with GC.
Gastric cancer Cancer stem cells PCNA Ki67 E-cadherin Prognosis
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The authors would like to thank all patients for their cooperation. This study was supported by grants from the National Natural Science Foundation of China (No. 81470287) and the National Natural Science Foundation of China (No. 81370661).
Conflict of interest
The authors declared no potential conflicts of interest in this work.
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