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Keratinization of Lung Squamous Cell Carcinoma Is Associated with Poor Clinical Outcome.

 Hye Jung Park  ;  Yoon-Jin Cha  ;  Seong Han Kim  ;  Arum Kim  ;  Eun Young Kim  ;  Yoon Soo Chang 
 Tuberculosis and Respiratory Diseases, Vol.80(2) : 179-186, 2017 
Journal Title
 Tuberculosis and Respiratory Diseases 
Issue Date
Bcl-X Protein ; Carcinoma, Squamous Cell ; Lung
BACKGROUND: Although the World Health Organization (WHO) classification of lung squamous cell carcinoma (SCC) was revised in 2015, its clinical implications for lung SCC subsets remain unclear. We investigated whether the morphologic characteristics of lung SCC, including keratinization, were associated with clinical parameters and clinical outcome of patients. METHODS: A total of 81 patients who underwent curative surgical resection of diagnosed lung SCC, were enrolled in this study. Attributes such as keratinization, tumor budding, single cell invasion, and nuclear size within the tumor, as well as immunohistochemistry of Bcl-xL and pS6 expressions, were evaluated. RESULTS: The keratinizing and nonkeratinizing subtypes did not differ with respect to age, sex, TNM stage, and morphologic parameters such as nuclear diameter, tumor budding, and single cell invasion at the tumor edge. Most patients with the keratinizing subtype (98.0%) had a history of smoking, whereas the nonkeratinizing group had a relatively higher proportion of never-smokers relative to the keratinizing group (24.0% vs. 2.0%; p=0.008, chi-square test). Expression of pS6 (a surrogate marker of mammalian target of rapamycin complex 1 [mTORC1] signaling that regulates keratinocyte differentiation), and Bcl-xL (a key anti-apoptotic molecule that may inhibit keratinization), did not correlate significantly with the presence of keratinization. Patients with the keratinizing subtype had a significantly shorter overall survival (85.2 months vs. 135.7 months, p=0.010, log-rank test), and a multivariate analysis showed that keratinization was an independent, poor prognostic factor (hazard ratio, 2.389; 95% confidence interval, 1.090-5.233; p=0.030). CONCLUSION: In lung SCC, keratinization is associated with a poor prognosis, and might be associated with smoking.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
김성한(Kim, Seong Han)
김은영(Kim, Eun Young) ORCID logo https://orcid.org/0000-0002-3281-5744
박혜정(Park, Hye Jung) ORCID logo https://orcid.org/0000-0002-1862-1003
장윤수(Chang, Yoon Soo) ORCID logo https://orcid.org/0000-0003-3340-4223
차윤진(Cha, Yoon Jin) ORCID logo https://orcid.org/0000-0002-5967-4064
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