
Prognostic implications of decreased microRNA‑101‑3p expression in patients with non‑small cell lung cancer
- Authors:
- Published online on: October 9, 2018 https://doi.org/10.3892/ol.2018.9559
- Pages: 7048-7056
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Copyright: © Lu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Abstract
Introduction
Lung cancer is the most frequently diagnosed cancer and was reported in 2015 as the leading cause of cancer-associated mortalities globally, as its incidence and mortality rate have been increasing in numerous countries, including China (1). Of the lung cancer instances, ~80% are non-small cell lung cancer types (NSCLC), which are clinically and pathologically different from SCLC types (2). Treatment options for lung cancer include surgery, radiation therapy, chemotherapy and targeted therapy. Therapeutic modalities depend on a number of factors, including the type and stage of cancer (3). Despite ongoing therapeutic efforts, patients with lung cancer have a poor prognosis with an arithmetic average 5-year survival rate of 15% (4). This is primarily due to inadequate knowledge regarding tumor progression and its associated molecular alterations, which delay diagnosis (5); therefore, improvements in molecular genetics diagnosis and prediction of prognosis for targeted treatments and clinical decisions are required.
microRNAs (miRNAs) are a class of non-coding single stranded RNA molecules of ~22 nucleotides, which are encoded by endogenous genes (6). miRNAs are important regulators of gene expression in plants and animals (7). Recent studies have determined that miRNAs are associated with the formation and suppression of tumors (8–10). Changes in miRNA expression may serve an essential role in tumorigenesis and cancer inhibition. A number of miRNAs act as tumor suppressors, while others stimulate tumor growth. For example, there is reduced miR-143 expression in patients with colorectal cancer (11), miR-15-a and miR-16-1 are reduced in patients with B cell chronic lymphocytic leukemia (12), precursor miR-155 is highly expressed in Burkitt lymphoma, and the miR-17/92 cluster has been determined to be highly expressed in lung cancer, particularly in patients with SCLC (13,14). Additionally, miR-608 regulates apoptosis in human lung cancer via the regulation of AKT serine/threonine kinase (Akt)2, and miR-99a suppresses the invasion and migration of NSCLC cells (15). miR-101-3p is a member of the miR-101 family, and a recent study indicated that it has tumor suppressor effects in patients with NSCLC (16). However, to the best of our knowledge, a limited number of studies have addressed the association between miR-101-3p and adjuvant chemotherapy in patients with NSCLC (17–19).
In the present study, the miR-101-3p expression was investigated using the Gene Expression Omnibus (GEO) database and the expression levels of miR-101-3p in NSCLC tissues was evaluated using quantitative polymerase chain reaction (qPCR). Additionally, the association between miR-101-3p and prognosis following adjuvant chemotherapy was investigated in patients with NSCLC.
Materials and methods
Compliance with ethical standards
The present study was approved by the Ethics Committee of Shanghai Tenth People's Hospital, Tongji University School of Medicine (approval no. SHSY-IEC-pap-15-18; Shanghai, China). Each participant provided signed informed consent prior to participate in the present study. Patients or their legal surrogates provided signed informed consent for the surgical procedures. All specimens were handled and anonymized according to ethical and legal standards.
miRNA expression in NSCLC from the GEO database
The expression levels of miRNAs were assessed in NSCLC tissues and normal tissue samples from the GEO database (http://www.ncbi.nlm.nih.gov/geo/) (20–23) using the following keywords: ‘Homo sapiens’; ‘NSCLC’ and ‘miRNA’. All datasets used the Illumina or Agilent Array platform to detect signals. For quality control, exclusion criteria for probes were as follows: i) had a low bead count of <3 in at least 5% of samples and ii) indicated a detection-P>0.05 in at least 5% of samples (20). The raw data set GSE61741 (21) was downloaded, which provided the peripheral blood miRNA profiles from 94 healthy controls and 73 patients with lung cancer. Additionally, GSE24709 (22) (including 19 healthy controls and 28 patients with lung cancer) and GSE56036 (23) (including 29 health controls and 23 patients with NSCLC) were downloaded in the GEO datasets to identify differentially expressed miRNAs in NSCLC samples and adjacent non-tumor tissues. Fold change (FC ≥2) and P<0.05 served as basic screening parameters. Hierarchical clustering was performed using the multiple experiment viewer 4.7.1 software programs (http://www.tm4.org/).
Clinical specimens
A total of 327 lung cancer tissues were collected from 206 male patients and 121 female patients with lung cancer who underwent surgery in Shanghai Tenth People's Hospital of the Tongji University School of Medicine (Shanghai, China) between January 2004 and December 2016. Inclusion criteria consisted of the following: ≤75 years with histologically proven NSCLC; no severe major organ dysfunction; World Health Organization (WHO) performance status of 0 or 1 and no prior cancer chemotherapy. Exclusion criteria consisted of the following: Age ≥76; severe major organ dysfunction; WHO performance status of >1 or prior cancer chemotherapy. Clinical information of the patients were recorded, including sex, age, smoking history, the diameter and differentiation of the tumor, lymph node metastasis, stage of Tumor-Node-Metastasis (TNM), histological grade, degree of invasion of the lung membrane, degree of vascular invasion, whether chemotherapy had been administered, overall survival (OS) rate, disease-free survival (DFS) rate and miR-101-3p expression status. Each participant provided signed informed consent prior to participation in the present study. Patients or their legal surrogates provided signed informed consent for the surgical procedures.
RNA extraction and detection of miR-101-3p expression by qPCR
RNA, including miRNAs, from NSCLC and normal tissue samples, were extracted using TRIzol® reagent (Thermo Fisher Scientific, Inc., Waltham, MA, USA), according to the manufacturer's protocols and an optimized protocol (13). RNA concentration was measured using NanoDrop ND-1000 (Thermo Fisher Scientific, Inc.) and the quality was assessed using electrophoresis in 1.5% denaturing agarose gels and viewed on a Kodak Gel Logic 2200 imaging system (Kodak, Rochester, NY, USA). TaqMan probe-based qPCR was carried out using a commercial kit (cat. no., A25576; Applied Biosystems; Thermo Fisher Scientific, Inc.), according to the protocol of the manufacturer (24). RT reactions were performed using AMV Reverse Transcriptase (Takara Biotechnology Co., Ltd., Dalian, China) and qPCR was performed using a standard TaqMan PCR kit protocol on the Applied Biosystems 7900HT Sequence Detection system (Thermo Fisher Scientific, Inc.), according to the manufacturer's protocols. qPCR for miR-101-3p was executed using the TaqMan® universal PCR kit (Thermo Fisher Scientific, Inc.), according to the manufacturer's protocols. Thermocycling conditions were as follows: Initial denaturation at 94°C for 10 min, followed by 35 cycles of 94°C for 30 sec, 60°C for 30 sec and 72°C for 30 sec, with a final extension at 72°C for 10 min. Each reaction was independently tested in duplicate at a minimum of three times. The following primers were used: miR-101-3p, forward, 5′-GGTCACTAAGGCGGT-3′ and reverse, 5′-CAGTCGTTGCGTCGGAGT-3′; U6, forward, 5′-CTGGTTAGTACTTGGACGGGAGAC-3′ and reverse, 5′-GTGCAGGGTCCGAGGT-3′. U6 was used as the endogenous control and the 2−ΔΔCq method was used to analyze expression levels (25).
Statistical analysis
Expression levels of miR-101-3p were summarized and presented as the mean ± standard deviation. All statistical analyses were performed with IBM SPSS statistics software version 20.0 for Windows (IBM Corp., Armonk, NY, USA). The paired Student's t-test was used to determine the difference between two groups of data. The χ2 test was used to evaluate the differences among groups. Kaplan-Meier estimator curves and the log-rank test were performed to analyze the OS or DFS of patients with NSCLC. Hierarchical clustering was performed using the multiple experiment viewer 4.7.1 software programs: (http://www.tm4.org/mev/), according to the manufacturer's protocols. Univariate and multivariate Cox proportional hazards regression models were used to investigate the multiple characteristics associated with the prognosis of patients with NSCLC. P<0.05 was considered to indicate a statistically significant difference.
Results
Expression of miR-101-3p using the GEO database and clustering analysis
Firstly, miR-101-3p expression analysis was performed using data from the GEO database. GSE24709 included the miRNA profile in peripheral blood samples from patients with lung diseases and healthy controls. The present analysis demonstrated that miR-101-3p expression in NSCLC tissues was significantly reduced, compared with non-tumor tissue (FC, 1.5; P<0.00001; Fig. 1A and B). The miR-101-3p expression was validated in NSCLC tissues in two datasets (GSE56036 and GSE61741) and indicated that miR-101-3p levels were significantly reduced in NSCLC tissues, compared with normal tissues (P=0.005, Fig. 1C; P=0.009, Fig. 1D).
miR-101-3p expression in NSCLC and adjacent non-tumor tissues
Expression of miR-101-3p was evaluated in NSCLC samples (n=327) and compared with adjacent non-tumor tissue (n=42) by qPCR. The present results indicated that miR-101-3p expression levels were significantly reduced in NSCLC tissues, compared with adjacent non-tumor tissues (FC, 0.36; P=0.002; Fig. 2A). The level of miR-101-3p expression was 0.72±0.04 in 327 NSCLC tissues, which was significantly reduced compared with normal tissues (n=42; 1.28±0.16) (FC, 0.56; P=0.117; Fig. 2B).
Association between clinical characteristics and miR-101-3p expression
Additionally, miR-101-3p expression was analyzed in NSCLC samples based on various clinical characteristics, including age, sex, smoking history, lymph node metastasis, tumor differentiation, histology, TNM stage, invasion of lung membrane, vascular invasion and tumor diameter. Univariate analysis demonstrated that miR-101-3p expression was significantly associated with lymph node metastasis (P=0.08), tumor diameter (P=0.019) and TNM stage (P=0.036) in all patients with NSCLC (Table I). However, no significant association was determined between miR-101-3p expression in NSCLC samples and age, sex, smoking history, tumor differentiation, histology, invasion of the lung membrane or vascular invasion (P>0.05; Table I).
Univariate analysis of prognosis based on various clinical characteristics in patients with NSCLC
To ascertain whether the prognosis of patients with NSCLC was influenced by age, sex, smoking history, lymph node metastasis, tumor differentiation, histology, TNM stage, invasion of lung membrane, vascular invasion, tumor diameter or miR-101-3p expression, univariate analysis with the Kaplan-Meier estimator method was performed. The results demonstrated that lymph node metastasis (P=0.042), TNM stage (P=0.018), tumor diameter (P=0.013) and miR-101-3p expression were significantly associated with OS (P=0.004) and DFS (P=0.001) (Table II; Fig 2).
![]() | Table II.Univariate analysis of OS and DFS based on patients stratified by clinical characteristics. |
Univariate Cox regression analysis revealed that lymph-node metastasis [hazard ratio (HR), 1.743; 95% confidence interval (CI), 1.191–2.421; P=0.032], TNM stage (HR, 1.562; 95% CI, 1.124–1.962; P=0.036), tumor diameter (HR, 2.125; 95% CI, 1.563–3.346; P=0.005), chemotherapy (HR, 0.778; 95% CI, 0.469–0.968; P=0.026) and miR-101 expression (HR, 0.687; 95% CI, 0.498–0.952; P=0.003) were also positively significantly associated with a poor prognosis. No significant associations were observed for age, sex, smoking history, tumor differentiation, histology, invasion of lung membrane or vascular invasion (Table III).
![]() | Table III.Cox regression model analysis for prognosis based on various clinical characteristics in patients with NSCLC. |
Cox regression model analysis of prognosis based on various clinical characteristics in patients with NSCLC
To determine whether miR-101-3p expression levels, in combination with lymph-node metastasis, TNM stage or tumor diameter had prognostic value, multivariate analysis with a Cox regression model was used (Table II). This analysis also indicated that lymph node metastasis (HR, 1.924; 95% CI, 1.386–3.405; P=0.014), TNM stage (HR, 1.967; 95% CI, 1.544–2.325; P=0.018) and tumor diameter (HR, 2.869; 95% CI, 2.025–3.396; P=0.002) were significantly associated with reduced prognosis (Table III). This analysis initially included all of the parameters that were predictive of OS in the univariate analysis of the entire study group as presented in Table II (age, sex, smoking history, lymph-node metastasis, tumor differentiation, histology, vascular invasion, tumor diameter and invasion of the lung membrane).
Prediction of OS and DFS for patients with NSCLC based on chemotherapy alone or chemotherapy and miR-101-3p expression
There was a statistically significant association between chemotherapy and OS (27.624±3.858 vs. 31.457±2.924, respectively; P=0.012) and DFS (26.985±2.247 vs. 31.004±3.357, respectively; P=0.005) in patients with NSCLC. Chemotherapy is the primary adjuvant treatment for the majority of patients with NSCLC undergoing surgery. In the present study, it was determined that adjuvant chemotherapy and high expression of miR-101-3p increased the OS and DFS of patients (32.738±3.574 and 31.946±3.789, respectively) compared with non-therapeutic patients with low expression of miR-101-3p (25.352±2.568 and 25.004±2.876, respectively) (Table IV). These data indicated that patients with NSCLC with a high expression of miR-101-3p may have an increased benefit from chemotherapy.
![]() | Table IV.OS and DFS of patients with NSCLC based on chemotherapy alone or chemotherapy and miR-101 expression. |
Discussion
Lung cancer is the most common type of malignant tumor and was reported in 2015 as the leading cause of cancer-associated mortality worldwide (26). Drug resistance has remained the primary factor influencing prognosis, therefore the treatment of advanced and metastatic NSCLC remains a notable challenge (27). The recognition of novel biomarkers for prediction of patient response to chemotherapy and prognosis is essential for improving OS and DFS in patients with NSCLC.
As molecular biomarkers, miRNAs serve significant roles in the selection of therapeutic schedules. Their functions as tumor suppressors and oncogenes in human cancer have been previously reported (28). In lung cancer, miRNAs exhibit alterations in expression that predict survival and relapse (29). miR-101 inhibits ovarian cancer cell invasion and proliferation by downregulating the expression of suppression of cytokine signaling 2 (30), and also has implications in suppressing the spread of a number of tumor types, including chondrosarcoma (31), thyroid cancer (32), breast cancer (33) and hepatocellular carcinoma (34). It has been reported that miR-101 inhibits cell proliferation and invasion of lung cancer by regulating cyclooxygenase-2 (35). Additionally, low expression of miR-101 in lung cancer has been demonstrated to inhibit the invasion of lung cancer by regulating its target gene enhancer of zerte 2 polycomb repressive complex 2 subunit (36).
miR-101-3p is a member of the miR-101 family and inhibits the metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1)-induced activation of the phosphoinositide 3-kinase/Akt signaling pathway, resulting in the inhibition of NSCLC growth and metastasis (16). It is notable that miR-101-3p expression in NSCLC cells was significantly reduced, whereas MALAT-1 expression was significantly increased. Furthermore, high expression of miR-101-3p inhibits the proliferation, migration and invasion of NSCLC (37). In the present study, significantly reduced levels of miR-101-3p was observed in patients with NSCLC, compared with healthy controls. The level of miR-101-3p expression in NSCLC was determined to be associated with OS and DFS, indicating that miR-101-3p may serve as a prognostic biomarker in patients with NSCLC. The analysis of a number of clinical factors, including tumor diameter, TNM stage and lymph node metastasis, demonstrated associations with OS and DFS. Notably, as an independent parameter, miR-101-3p expression levels in NSCLC also affected prognosis and survival.
miR-101-3p is a valuable prognostic predictor and therapeutic target of clinical chemotherapy. The present analysis determined that a high level of expression of miR-101-3p in patients with NSCLC who had undergone routine chemotherapy was positively associated with OS and DFS rates. This indicated that patients with NSCLC with high levels of miR-101-3p expression may have improved benefit from chemotherapy. In brief, miR-101-3p was significantly downregulated in NSCLC, which increased the OS and DFS rates of patients receiving adjuvant chemotherapy. Based on these results, whether the miR-101-3p expression level may serve as a biomarker for chemotherapy use in patients with NSCLC should be investigated, and therefore may be a valuable and promising biomarker for this disease. However, the molecular and pathophysiological mechanisms of miR-101-3p in NSCLC are not fully understood, and will be assessed in subsequent studies. The present study had a number of limitations. For example, this is a retrospective study and only one marker was addressed. There are other markers or associated pathways that must be studied. In the future, multicenter studies regarding miR-101-3p in NSCLC should be performed.
In conclusion, the present data confirmed that with adjuvant chemotherapeutic treatment the median OS and DFS rate of patients improved. The analyses demonstrated that low expression of miR-101-3p, together with adjuvant chemotherapy, notably improved the OS and DFS of patients with NSCLC. The use of miR-101-3p as a specific and sensitive biomarker may be suitable for prediction of therapeutic responses in patients with advanced NSCLC, which may result in a superior level of personalized therapy. Therefore, miR-101-3p may be considered as a potential biomarker for chemosensitivity in the tumors of patients with NSCLC.
Acknowledgements
We would like to thank the experimental support of Central Laboratory for Medical Research, Shanghai Tenth People's Hospital (Shanghai, China).
Funding
The present study was partially supported by grants from the National Natural Science Foundation of China (grant nos. 81472202, 81772932, 81201535, 81302065, 81301993, 81702243, 81260345 and 81372175), Shanghai Natural Science Foundation (grant nos. 12ZR1436000 and 16ZR1428900), Shanghai Municipal Commission of Health and Family Planning (grant nos. 201540228 and 201440398), Program of Shanghai Subject Chief Scientist (grant no. 04.01.13.059), The Fundamental Research Funds for the Central Universities (grant no. 22120170212 and 22120170117), Clinical Research Special Foundation of the Wu Jieping Medical Foundation (grant no. 320.6750.14326) and Nantong Science and Technology Project (grant no. yyz15026).
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Authors' contributions
HML, WWY, YSM, FY, JBL, and DF designed the study. HML, WWY, FY, YSM, WTX, HWF, ZWL, LKH, WW, JJJ, ZYC, MXS, YCS, LC, CYJ, GXL and DF performed the qPCR experiments. HML, WWY, FY, YSM, WTX, LKH, WW, MXS, HQY, CZ, LC, CYJ, GXL, CYW and DF performed the statistical analyses and interpreted the data. FY, YSM, ZWL, LKH, WW, HML, JJJ, MXS, LC, CYJ, GXL, CYW, XJZ, JBL, and DF are involved in patient recruitment. FY, YSM, ZWL, CYW, JBL, and DF contributed to study materials and consumables. FY, YSM, ZWL, WTX and DF wrote the manuscript. HML, WWY, YSM, WW and FY contributed equally to this work. All authors agreed with the results and conclusions.
Ethics approval and consent to participate
The present study was approved by the Ethics Committee of Shanghai Tenth People's Hospital, Tongji University School of Medicine (approval no. SHSY-IEC-pap-15-18). Each participant provided signed informed consent prior to participate in the present study. Patients or their legal surrogates provided signed informed consent for the surgical procedures.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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