Prognostic value of nuclear maspin expression for adjuvant 5-fluorouracil-based chemotherapy in advanced gastric cancer

Abstract

To assess the prognostic and predictive value of maspin expression for the clinical response to 5-fluorouracil (5-FU)-based chemotherapy in advanced gastric cancer (GC) patients, the expression of maspin in primary tumors from 127 patients with advanced GC was examined using immunohistochemistry. Of the 127 patients, 74 were treated with surgery alone and 53 received additional adjuvant 5-FU-based chemotherapy. Nuclear and cytoplasmic maspin expression was observed in 46.5 (59/127) and 68.5% (87/127) of patients, respectively. Nuclear maspin immunoreactivity was significantly associated with larger tumor size (p=0.036), the depth of tumor invasion (p=0.02) and lymph node metastasis (p=0.002). Cytoplasmic maspin immunoreactivity was associated with tumor cell differentiation but not with the other clinicopathological variables. Nuclear maspin immunoreactivity had a significant association with overall survival (OS). Among the nuclear maspin-expressing patients, those who were treated with 5-FU-based adjuvant chemotherapy showed significantly longer OS than those without chemotherapy (p=0.0004). In conclusion, nuclear maspin expression is associated with adverse clinical outcomes in patients with advanced GC. Patients with positive nuclear maspin expression may be more responsive to adjuvant 5-FU chemotherapy.

Figure 1.

Representative immunohistochemical maspin staining in gastric cancer. Tumor cells with (A) negative nuclear and cytoplasmic staining, (B) negative nuclear and weakly positive cytoplasmic staining, (C) weakly positive nuclear and negative cytoplasmic staining, (D) positive nuclear and cytoplasmic staining.

Figure 2.

Distribution of time (months) to mortality as estimated using the Kaplan-Meier method. (A) Overall survival of all patients with negative and positive nuclear maspin immunoreactivity. (B and C) Subgroup analysis of overall survival for patients with (B) negative or (C) positive nuclear maspin immunoreactivity in the surgery and adjuvant therapy groups.