Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2015; 21(31): 9403-9412
Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9403
High expression of CD11c indicates favorable prognosis in patients with gastric cancer
Yuan Wang, Bin Xu, Wen-Wei Hu, Lu-Jun Chen, Chang-Ping Wu, Bin-Feng Lu, Yue-Ping Shen, Jing-Ting Jiang
Yuan Wang, Bin Xu, Wen-Wei Hu, Lu-Jun Chen, Chang-Ping Wu, Jing-Ting Jiang, Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
Yuan Wang, School of Clinical Medicine, North China University of Science and Technology, Tangshan 063000, Hebei Province, China
Bin-Feng Lu, Department of Immunology, University of Pittsburgh, Pittsburgh, PA 15213, United States
Yue-Ping Shen, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou 215123, Jiangsu Province, China
Author contributions: Wang Y and Xu B contributed equally to this work; Wang Y and Xu B contributed substantially to the conception and design of the study; Wang Y, Hu WW and Chen LJ performed research; Wang Y, Xu B and Shen YP performed analysis and interpretation of all data and drafted the article; Wu CP and Lu BF critically read the manuscript; Jiang JT and Shen YP supervised the study and revised the manuscript.
Supported by National Natural Science Foundation of China, No. 81171653, No. 81301960 and No. 31428005; and Natural Science Foundation of Jiangsu Province, China, No. BK2011246 and No. BK2011247.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jing-Ting Jiang, MD, PhD, Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, No. 185 Juqian Road, Changzhou 213003, Jiangsu Province, China. jiangjingting@suda.edu.cn
Telephone: +86-519-68870884 Fax: +86-519-68870978
Received: April 7, 2015
Peer-review started: April 8, 2015
First decision: April 23, 2015
Revised: May 1, 2015
Accepted: June 10, 2015
Article in press: June 10, 2015
Published online: August 21, 2015
Processing time: 134 Days and 23.6 Hours
Abstract

AIM: To determine the relationship between CD11c expression level and prognosis in patients with gastric cancer (GC).

METHODS: This retrospective survival study was performed from July 31, 2008 to June 30, 2014. Our study inclusion criteria included all the patients with GC who underwent surgical resection between January 1998 and December 2009 in the Third Affiliated Hospital of Soochow University. CD11c expression levels in 140 patients with GC at different UICC stages were evaluated using immunohistochemistry, and GC tissues from 16 cases were further verified by qRT-PCR. The χ2 test was used to compare the patient- and disease-related factors between the low CD11c expression group and the high expression group. Univariate probabilities of overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method. The log rank test was used to compare survival curves. Different multivariate COX models were used to estimate the association between CD11c expression and both death and recurrence risk in GC patients.

RESULTS: The average CD11c expression level was 5.1 ± 1.8/high power field (HPF) in 10 gastritis samples, 4.5 ± 2.3/HPF in 10 gastric polyp samples and 9.7 ± 6.3/HPF in 140 gastric cancer samples, respectively. The CD11c expression level was significantly decreased from UICC stage I to stage IV (stage I: 16.0 ± 7.4, stage II: 10.4 ± 5.5, stage III: 9.4 ± 6.1, stage IV: 5.3 ± 3.2, P < 0.001). Patients in the high CD11c expression group had a greater 3- and 5-year OS probability and longer median survival time compared with the low CD11c expression group, (67.7% vs 39.2%; 51.4% vs 29.0%; 67.0 mo vs 28.0 mo; χ2 = 6.80, P = 0.009), and had a greater 3- and 5-year DFS probability and longer median DFS time (63.7% vs 24.0%; 49.1% vs 11.9%; 64.0 mo vs 18.0 mo; χ2 = 15.39, P < 0.001). Patients with high CD11c high expression had a reduced risk of death (HR = 0.56, 95%CI: 0.33-0.98, P < 0.05) and relapse (HR = 0.39, 95%CI: 0.23-0.67, P < 0.01) compared with patients with low CD11c expression after adjustment of potential confounders, with the exception of tumor size. However, the protective effect related to death (HR = 0.90, 95%CI: 0.49-1.67, P = 0.749) and relapse (HR = 0.65, 95%CI: 0.36-1.19, P = 0.160) disappeared when tumor size was incorporated into the model.

CONCLUSION: High expression of CD11c decreased the risk of death and relapse, and may be regarded as an alternative indicator of favorable prognosis in patients with GC.

Keywords: CD11c; Gastric cancer; Dendritic cell; Tumor microenvironment

Core tip: The progression of gastric cancer is closely related to the tumor microenvironment. In the present study, we found that CD11c expression level significantly decreased from UICC stage I to stage IV, and patients with high CD11c expression had a reduced risk of death and relapse compared with patients with low CD11c expression after adjustment of potential confounders, with the exception of tumor size. Based on our research, we suggest that high expression of CD11c decreased the risk of death and relapse and may act as an indicator of favorable prognosis in patients with gastric cancer.