Clinicopathological Assessment of Cancer/Testis Antigens NY-ESO-1 and MAGE-A4 in Highly Aggressive Soft Tissue Sarcomas

Abstract

We aimed to investigate the clinical significance of the expression of NY-ESO-1 and MAGE-A4 in soft tissue sarcoma (STS). Immunostaining for NY-ESO-1, MAGE-A4, and Ki67 was performed using pathological specimens harvested from 10 undifferentiated pleomorphic sarcoma (UPS), nine myxofibrosarcoma (MFS), and three malignant peripheral nerve sheath tumor (MPNST) patients treated at our hospital. We examined the correlation of NY-ESO-1 and MAGE-A4 expression levels with tumor size, histological grade, and SUVmax values. Positive cell rates of various markers were also compared between patients in remission and those who were not in remission. The rates of cases positive for NY-ESO, MAGE-A4, and Ki67 were 50%, 63.6%, and 90.9%, respectively. The average rates of cells positive for NY-ESO, MAGE-A4, and Ki67 in all STS types were 18.2%, 39.4%, and 16.8%, respectively. A positive correlation was observed between rates of cells positive for NY-ESO-1 and MAGE-A4 and between NY-ESO-1 and MAGE-A4 expression levels and clinical features. There was no significant difference in the positive cell rate of NY-ESO-1 or MAGE-A4 between remission and non-remission cases. Our results suggest that NY-ESO-1 and MAGE-A4 expression may be useful for the diagnosis and prognostication of UPS, MFS, and MPNST.

Keywords: MAGE-A4; NY-ESO-1; antigens; soft tissue sarcoma.

Figure 1

Representative histopathological findings in undifferentiated pleomorphic sarcoma (UPS) (a), myxofibrosarcoma (MFS) (b), and malignant peripheral sheath tumor (MPNST) (c). Hematoxylin and eosin (HE) staining (a–c). Representative NY-ESO-1-positive histological findings in UPS (d), MFS (e), and MPNST (f). Representative MAGE-A4-positive histological findings in UPS (g), MFS (h), and MPNST (i). Representative Ki67-positive histological findings in UPS (j), MFS (k), and MPNST (l). NY-ESO and MAGE-A4 show staining in the cytoplasm, whereas Ki67 shows staining in the nucleus (d–l). The lower right inset image was used as the negative control for each immunostaining image (d–l). Scale bar = 100 µm.

Figure 2

Graphs showing no positive correlation between the NY-ESO-1 and MAGE-A4 expression levels (r = 0.22) in sarcomas (a); weak positive correlation between the NY-ESO-1 and Ki67 expression levels (r = 0.65) in sarcomas (b); and weak positive correlation between the MAGE-A4 and Ki67 expression levels (r = 0.54) in sarcomas (c).

Figure 3

Graphs showing the weakly positive correlation between age and NY-ESO-1 expression (r = 0.48) in sarcomas (a); weak positive correlation between the age and MAGE-A4 expression (r = 0.70) in sarcomas (b); weak positive correlation between the tumor size and NY-ESO-1 expression (r = 0.46) in sarcomas (c); weak positive correlation between the tumor size and MAGE-A4 expression (r = 0.61) in sarcomas (d).

Figure 4

Graphs showing a weakly positive correlation between histological grade and NY-ESO-1 expression (r = 0.53) in sarcomas (a); very strong positive correlation between the histological grade and MAGE-A4 expression (r = 0.72) in sarcomas (b); no correlation was observed between the maximum standardized uptake value (SUVmax) and NY-ESO-1 expression (r = 0.26) in sarcomas (c); weak positive correlation between the SUVmax and MAGE-A4 expression (r = 0.53) in sarcomas (d).