The expression of TTF-1 and Napsin A in early-stage lung adenocarcinoma correlates with the results of surgical treatment

Abstract

Non-small cell lung cancer (NSCLC) accounts for 80 % of lung cancers, and lung adenocarcinoma (ADC) is one of the main types of NSCLC. Although there are several studies on the relationship between lung ADC immunohistochemical diagnostic markers (thyroid transcription factor 1 (TTF-1) and Napsin A) and survival, some aspects of those studies could be improved. We examined the significance of the commonly used lung ADC diagnostic markers, including TTF-1, Napsin A, and CK7, in the prognosis of early-stage lung ADC. One hundred and nineteen cases of early-stage lung ADC (N0) were selected from the prospective database of lung cancer (Jan 2000 to Dec 2009). The expression levels of TTF-1, Napsin A, and CK7 in inventoried specimens were analyzed using tissue microarray (TMA) and immunohistochemical (IHC) analysis, and the effect of the expression level of each marker on patients' survival was examined. The diagnostic sensitivity and specificity of each marker for lung ADC were as follows: TTF-1, 87.0 and 90.1 %; Napsin A, 72.2 and 90.4 %; and CK7, 94.6 and 76.0 %, respectively. Patients with high expression levels of TTF-1 and Napsin A, and high co-expression levels of TTF-1/Napsin A had better survival rates than those with low levels of expression (P < 0.05). The expression levels of CK7 were not related to patients' survival. Multivariate analysis showed that the expression levels of Napsin A and TTF-1/Napsin A are independent prognostic factors for survival. The IHC detection of TTF-1 and Napsin A in specimens should be routinely performed in postoperative early-stage lung ADC patients. Its significance lies not only in the differential diagnosis, but also in determining the prognosis.

Surfactant Protein A and Napsin A in the Immunohistochemical Characterization of Canine Pulmonary Carcinomas: Comparison With Thyroid Transcription Factor-1

“…26,29 A combination of immunohistochemical markers, including TTF-1, napsin A, and SP-A, is used to diagnose human pulmonary tumors. 12,18,[20][21][22]30,34,42 Expressed in normal lung and thyroid, TTF-1 is a nuclear transcription factor detected in more than 70% of human lung tumors. 18,[20][21][22]30,42 Napsin A, an aspartic proteinase involved in surfactant protein B processing, is detected in 70% to 90% of lung tumors, with higher expression associated with longer survival.…”

“…12,18,[20][21][22]30,34,42 Expressed in normal lung and thyroid, TTF-1 is a nuclear transcription factor detected in more than 70% of human lung tumors. 18,[20][21][22]30,42 Napsin A, an aspartic proteinase involved in surfactant protein B processing, is detected in 70% to 90% of lung tumors, with higher expression associated with longer survival. 12,18,20,30,34 Immunoreactivity for SP-A is observed in surfactant and in type II pneumocytes and in 45% to 60% of human pulmonary carcinomas.…”

“…18,[20][21][22]30,42 Napsin A, an aspartic proteinase involved in surfactant protein B processing, is detected in 70% to 90% of lung tumors, with higher expression associated with longer survival. 12,18,20,30,34 Immunoreactivity for SP-A is observed in surfactant and in type II pneumocytes and in 45% to 60% of human pulmonary carcinomas. 34,42 Although SP-A is reportedly less sensitive than TTF-1 or napsin A, it was highly specific in 1 study, with immunoreactivity detected in only 1 of 6 colorectal carcinomas of a total of 55 nonpulmonary tumors evaluated.…”

What we know about surgical therapy in early-stage non-small-cell lung cancer: a guide for the medical oncologist

“…The prognostic value of these markers was studied by Ma et al Patients with high expression levels of TTF1 and napsin A, and high coexpression levels of TTF1–napsin A had better survival rates than those with low levels of expression. The expression levels of CK7 did not have any statistically significant effect on patients’ survival 32. Genome analyses of endothelial cells identified genes specifically expressed by tumor endothelial cells called tumor endothelial markers.…”

Infrequent Immunohistochemical Expression of Napsin A in Endometrial Carcinomas

“…[11][12][13] Many studies have established and used napsin A as an immunohistochemical diagnostic marker to differentiate between primary lung adenocarcinomas and metastatic tumors. [14][15][16] Recently, Ma et al 17 have stated that napsin A is significant in the diagnosis and determination of the prognosis of lung adenocarcinoma. Other research groups have described napsin A as a specific marker not only for lung adenocarcinoma but also for renal cell carcinoma, as well as for ovarian clear cell adenocarcinoma.…”