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<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Molecular Medicine Reports</journal-id>
<journal-title-group>
<journal-title>Molecular Medicine Reports</journal-title>
</journal-title-group>
<issn pub-type="ppub">1791-2997</issn>
<issn pub-type="epub">1791-3004</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/mmr.2020.10958</article-id>
<article-id pub-id-type="publisher-id">mmr-21-03-1517</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Role of downregulated ADARB1 in lung squamous cell carcinoma</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Wang</surname><given-names>Xiang</given-names></name>
<xref rid="af1-mmr-21-03-1517" ref-type="aff">1</xref>
<xref rid="af2-mmr-21-03-1517" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Ren</surname><given-names>Xinxin</given-names></name>
<xref rid="af3-mmr-21-03-1517" ref-type="aff">3</xref></contrib>
<contrib contrib-type="author"><name><surname>Liu</surname><given-names>Wanli</given-names></name>
<xref rid="af1-mmr-21-03-1517" ref-type="aff">1</xref>
<xref rid="af2-mmr-21-03-1517" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Chen</surname><given-names>Xi</given-names></name>
<xref rid="af1-mmr-21-03-1517" ref-type="aff">1</xref>
<xref rid="af2-mmr-21-03-1517" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Wei</surname><given-names>Jie</given-names></name>
<xref rid="af1-mmr-21-03-1517" ref-type="aff">1</xref>
<xref rid="af2-mmr-21-03-1517" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Gong</surname><given-names>Zhicheng</given-names></name>
<xref rid="af1-mmr-21-03-1517" ref-type="aff">1</xref>
<xref rid="af2-mmr-21-03-1517" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Yan</surname><given-names>Yuanliang</given-names></name>
<xref rid="af1-mmr-21-03-1517" ref-type="aff">1</xref>
<xref rid="af2-mmr-21-03-1517" ref-type="aff">2</xref>
<xref rid="c1-mmr-21-03-1517" ref-type="corresp"/></contrib>
<contrib contrib-type="author"><name><surname>Xu</surname><given-names>Zhijie</given-names></name>
<xref rid="af4-mmr-21-03-1517" ref-type="aff">4</xref>
<xref rid="c2-mmr-21-03-1517" ref-type="corresp"/></contrib>
</contrib-group>
<aff id="af1-mmr-21-03-1517"><label>1</label>Department of Pharmacy, Xiangya Hospital, Central South University, P.R. China</aff>
<aff id="af2-mmr-21-03-1517"><label>2</label>National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, P.R. China</aff>
<aff id="af3-mmr-21-03-1517"><label>3</label>Center for Molecular Medicine, Xiangya Hospital, Key Laboratory of Molecular Radiation Oncology of Hunan Province, Central South University, P.R. China</aff>
<aff id="af4-mmr-21-03-1517"><label>4</label>Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China</aff>
<author-notes>
<corresp id="c1-mmr-21-03-1517"><italic>Correspondence to</italic>: Dr Yuanliang Yan, Department of Pharmacy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, P.R. China, E-mail: <email>yanyuanliang@csu.edu.cn</email></corresp>
<corresp id="c2-mmr-21-03-1517">Dr Zhijie Xu, Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, P.R. China, E-mail: <email>xzj1322007@csu.edu.cn</email></corresp>
</author-notes>
<pub-date pub-type="ppub"><month>03</month><year>2020</year></pub-date>
<pub-date pub-type="epub"><day>23</day><month>01</month><year>2020</year></pub-date>
<volume>21</volume>
<issue>3</issue>
<fpage>1517</fpage>
<lpage>1526</lpage>
<history>
<date date-type="received"><day>10</day><month>07</month><year>2019</year></date>
<date date-type="accepted"><day>17</day><month>12</month><year>2019</year></date>
</history>
<permissions>
<copyright-statement>Copyright: &#x00A9; Wang et al.</copyright-statement>
<copyright-year>2020</copyright-year>
<license license-type="open-access">
<license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p></license>
</permissions>
<abstract>
<p>Non-small cell lung cancer (NSCLC) is prevalent worldwide. Lung squamous cell carcinoma (LUSC) is one of the main subtypes of NSCLC yet, currently, few biomarkers are available for the diagnosis of LUSC. The present study aimed to investigate the expression and role of adenosine deaminase RNA specific B1 (ADARB1) in lung squamous cell carcinoma (LUSC). Integrative bioinformatics analysis was used to identify the effects of ADARB1 expression on the occurrence and prognosis of LUSC. The expression of ADARB1 was further examined by immunohistochemistry (IHC). Bioinformatics analysis suggested that ADARB1 was downregulated in LUSC, serving as a potential tumor suppressor, and these results were verified by IHC performed on a lung cancer tissue array. Clinical studies suggested that ADARB1 expression and methylation levels were significantly associated with patient characteristics in LUSC. Moreover, ADARB1 global methylation levels were upregulated in LUSC tissues compared with normal lung tissues. Higher methylation levels of cg24063645 were associated with shorter overall survival time of patients with LUSC. A negative correlation was identified between ADARB1 and epidermal growth factor receptor (EGFR) expression in LUSC. Using the Gene Expression Omnibus database, it was suggested that the expression of ADARB1 in LUSC was significantly different compared with that in lung adenocarcinoma. Furthermore, protein-protein interactions were studied and a biological process annotation analysis was conducted. The present study suggested that ADARB1 was downregulated in LUSC; therefore, ADARB1 may serve as a specific biomarker and a potential therapeutic target for LUSC.</p>
</abstract>
<kwd-group>
<kwd>adenosine deaminase RNA specific B1</kwd>
<kwd>expression</kwd>
<kwd>methylation</kwd>
<kwd>survival</kwd>
<kwd>therapeutics</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Lung cancer was the leading cause of cancer-related death worldwide in 2015 and non-small cell lung cancer (NSCLC) accounts for ~85&#x0025; of lung cancer cases (<xref rid="b1-mmr-21-03-1517" ref-type="bibr">1</xref>). Lung squamous cell carcinoma (LUSC) is one of the main subtypes of NSCLC. A previous study indicated that the 5-year overall survival (OS) rate for patients with LUSC is 17.7&#x0025; due to late diagnosis (<xref rid="b2-mmr-21-03-1517" ref-type="bibr">2</xref>). In addition, there have been limited opinions for LUSC treatment compared to lung adenocarcinoma (LUAD) although progress has been made in the treatment of NSCLC (<xref rid="b3-mmr-21-03-1517" ref-type="bibr">3</xref>&#x2013;<xref rid="b5-mmr-21-03-1517" ref-type="bibr">5</xref>). The reason is partly because there are more molecular abnormalities for LUSC in the discoidin domain receptor tyrosine kinase 2 and fibroblast growth factor receptor 1 genes (<xref rid="b6-mmr-21-03-1517" ref-type="bibr">6</xref>). Early identification of the disease would reduce the mortality rate of patients with LUSC who could benefit most from effective therapies (<xref rid="b7-mmr-21-03-1517" ref-type="bibr">7</xref>). However, few biomarkers are currently available for the effective diagnosis of LUSC, which would enable patients to receive timely treatment (<xref rid="b8-mmr-21-03-1517" ref-type="bibr">8</xref>). Thus, identifying novel target molecules is essential for improving the diagnosis and treatment of LUSC.</p>
<p>Adenosine deaminase RNA specific B1 (ADARB1) is a member of the adenosine deaminases acting on RNA (ADAR) family, which exhibit enzymatic editing activity in a process known as adenosine-to-inosine (A-to-I) editing (<xref rid="b9-mmr-21-03-1517" ref-type="bibr">9</xref>). Recently, research has indicated an association between ADARB1 and cancer. A previous study reported that ADARB1, an indispensable marker in brain development and function, could inhibit the proliferation and progression of glioblastoma (<xref rid="b10-mmr-21-03-1517" ref-type="bibr">10</xref>). In terms of esophageal squamous cell carcinoma, Chen <italic>et al</italic> (<xref rid="b11-mmr-21-03-1517" ref-type="bibr">11</xref>) reported that ADARB1 induces apoptosis and suppresses tumor growth by editing insulin-like growth factor binding protein 7 mRNA. Additionally, ADARB1 can regulate exon 12A, an exon from the heterogeneous nuclear ribonucleoprotein L like transcript, to promote cancer cell survival (<xref rid="b12-mmr-21-03-1517" ref-type="bibr">12</xref>). However, the relationship between ADARB1 and LUSC has not been investigated.</p>
<p>Therefore, the present study aimed to investigate the role of ADARB1 in LUSC. The results suggested that ADARB1 was downregulated in LUSC tissues and cell lines. The expression and methylation status of ADARB1 were significantly associated with clinical characteristics and prognosis. Additionally, the GSE10245 dataset (<xref rid="b13-mmr-21-03-1517" ref-type="bibr">13</xref>), acquired from the Gene Expression Omnibus (GEO) (<xref rid="b14-mmr-21-03-1517" ref-type="bibr">14</xref>) database, suggested that ADARB1 expression levels in LUSC were lower than in LUAD. Finally, functional enrichment analysis of ADARB1-associated co-expression genes was conducted and a protein-protein interaction (PPI) network was established. The results of the Gene Ontology (GO) analysis suggested that the main biological processes (&#x2018;metabolic process&#x2019; and &#x2018;biological regulation&#x2019;), cellular components (&#x2018;nucleus&#x2019;) and molecular functions (&#x2018;protein binding&#x2019;) were associated with ADARB1. In addition, ADARB1 expression was significantly related to the Kyoto Encyclopedia of Genes and Genomes (KEGG) terms &#x2018;ubiquitin mediated proteolysis&#x2019; and &#x2018;Wnt signaling pathway&#x2019;.</p>
</sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec>
<title/>
<sec>
<title>Data acquisition and reanalysis using bioinformatics methods</title>
<p>Several bioinformatics web resources were used to reanalyze data concerning ADARB1 (<xref rid="SD1-mmr-21-03-1517" ref-type="supplementary-material">Table SI</xref>). The Genome Mining (GE-mini) database was employed to examine gene expression profiles over a number of tissue types, including tumors (<xref rid="b15-mmr-21-03-1517" ref-type="bibr">15</xref>). The Cancer Cell Line Encyclopedia (CCLE) project is a public database containing detailed genetic and pharmacological characterization of numerous cell lines (<xref rid="b16-mmr-21-03-1517" ref-type="bibr">16</xref>). The GE-mini and CCLE databases were used to identify the expression profiles of ADARB1 in LUSC tissues and cell lines. Oncomine (<xref rid="b17-mmr-21-03-1517" ref-type="bibr">17</xref>), University of Alabama Cancer Database (UALCAN) (<xref rid="b18-mmr-21-03-1517" ref-type="bibr">18</xref>) and Gene Expression Profiling Interactive Analysis (GEPIA) (<xref rid="b19-mmr-21-03-1517" ref-type="bibr">19</xref>) were used to verify the results. The GEPIA database was also used to identify the Pearson correlation between ADARB1 and epidermal growth factor receptor (EGFR) in LUSC.</p>
<p>Wanderer is an interactive platform, which provides human cancer gene expression and DNA methylation data. This platform was used to evaluate the relationship between ADARB1 levels and patient clinical characteristics (<xref rid="b20-mmr-21-03-1517" ref-type="bibr">20</xref>). DiseaseMeth (version 2.0) is a human disease methylation database, which was used to analyze ADARB1 global methylation levels in LUSC (<xref rid="b21-mmr-21-03-1517" ref-type="bibr">21</xref>). The MethSurv tool was used to analyze the association between ADARB1 methylation and LUSC prognosis by using the mean value to dichotomize methylation profiles of patients (<xref rid="b22-mmr-21-03-1517" ref-type="bibr">22</xref>). The GSE10245 dataset, downloaded from the GEO database, provided ADARB1 expression profiles in LUAD and LUSC samples.</p>
<p>A dataset LUSC (TCGA, Nature 2012) (<xref rid="b23-mmr-21-03-1517" ref-type="bibr">23</xref>) from the cBioportal (<xref rid="b24-mmr-21-03-1517" ref-type="bibr">24</xref>) web tool was used to obtain gene co-expression data for ADARB1 in LUSC. The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database (<xref rid="b25-mmr-21-03-1517" ref-type="bibr">25</xref>) and Cytoscape software (<xref rid="b26-mmr-21-03-1517" ref-type="bibr">26</xref>) were then used to build a PPI network of the co-expression genes. Moreover, GO and KEGG (<xref rid="b27-mmr-21-03-1517" ref-type="bibr">27</xref>) pathway analyses were conducted, using the Web-based Gene Set Analysis Toolkit (WebGestalt) (<xref rid="b28-mmr-21-03-1517" ref-type="bibr">28</xref>) and the Database for Annotation, Visualization and Integrated Discovery (DAVID) (<xref rid="b29-mmr-21-03-1517" ref-type="bibr">29</xref>) bioinformatics resources, respectively.</p>
</sec>
<sec>
<title>Immunohistochemistry (IHC) analysis of a lung cancer tissue array</title>
<p>The LUC481 lung cancer tissue array and information regarding the cancer subtypes of the array were obtained from Fanpu Biotech, Inc. IHC was performed using the Histomouse SP Broad Spectrum DAB kit (Invitrogen; Thermo Fisher Scientific, Inc.) according to the manufacturer&#x0027;s protocol. Following antigen retrieval which was performed by microwaving in 10 mM citrate buffer (pH 6.0), paraffin-embedded sections were immunostained using a streptavidin peroxidase procedure. After blocking the samples with 3&#x0025; bovine serum albumin (100 ml, SW3015, Beijing Solarbio Science &#x0026; Technology Co., Ltd.) for 15 min at room temperature, the primary antibody against ADARB1 (cat. no. sc-73409, Santa Cruz Biotechnology, Inc., 1:100 dilution) was added and samples were incubated at 4&#x00B0;C overnight. Following washing with PBS, the horseradish peroxidase (HRP)-conjugated polymer second antibody (PV-6000, OriGene Technologies, Inc.) was added and samples were incubated for 30 min at room temperature. The signal was examined using a 3,3&#x2032;-diaminobenzidine solution. Subsequently, four fields of view of the stained sections were independently observed in a light microscope at magnifications of &#x00D7;4 and &#x00D7;20 by two pathologists. The staining intensity of each protein was divided into four grades (intensity scores): 0 (negative), 1 (weak brown), 2 (moderate brown) and 3 (strong brown). The percentage of positive cells was scored as 0 (&#x2264;10&#x0025;), 1 (11&#x2013;25&#x0025;), 2 (26&#x2013;50&#x0025;), 3 (51&#x2013;75&#x0025;) and 4 (&#x003E;75&#x0025;) (<xref rid="b30-mmr-21-03-1517" ref-type="bibr">30</xref>). The final staining score was calculated using the following formula: Intensity score &#x00D7; percentage score (<xref rid="b1-mmr-21-03-1517" ref-type="bibr">1</xref>). A final score &#x003E;1 was defined as high expression and final scores &#x2264;1 were defined as low expression.</p>
</sec>
<sec>
<title>Statistical analysis</title>
<p>Statistical analyses were performed using SPSS software (version 12.0; SPSS, Inc.). The data are presented as the mean &#x00B1; SD. A paired-sample t-test was used for normally distributed and continuous variables were statistically analyzed by one-way analysis of variance with LSD post hoc test. Multivariate analysis was accomplished utilizing the Cox regression model to identify independence of accepted clinical parameters and the ordinal variables were tested with Kruskall-Wallis test followed by Dunn&#x0027;s post-hoc test. The Kaplan-Meier analysis was statistically tested by the log-rank method. P&#x003C;0.05 was considered to indicate a statistically significant difference.</p>
</sec>
</sec>
</sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title/>
<sec>
<title>ADARB1 is downregulated in LUSC tissues and cell lines</title>
<p>By analyzing several databases, the transcriptional levels of ADARB1 in LUSC tissues and cell lines were compared with those observed in normal lung tissue and cells. GE-mini analysis revealed that ADARB1 mRNA expression was significantly decreased in LUSC tissues (<xref rid="f1-mmr-21-03-1517" ref-type="fig">Fig. 1A</xref>). The CCLE database suggested that ADARB1 mRNA expression was significantly downregulated in ~10 LUSC cell lines compared with immortalized lung epithelial cell lines (P=0.001; <xref rid="f1-mmr-21-03-1517" ref-type="fig">Fig. 1B</xref>). To further investigate these observations, the Oncomine, UALCAN and GEPIA databases were employed. Analysis with all three databases suggested that ADARB1 was expressed at significantly lower levels in LUSC tissues compared with in normal lung tissues (<xref rid="f1-mmr-21-03-1517" ref-type="fig">Fig. 1C-E</xref>). Furthermore, IHC analysis, based on a lung cancer array containing 16 normal samples, 12 LUSC samples and 10 LUAD samples, suggested that ADARB1 was significantly downregulated in LUSC samples compared with normal lung samples (P=1.58&#x00D7;10<sup>&#x2212;8</sup>; <xref rid="f2-mmr-21-03-1517" ref-type="fig">Fig. 2A and B</xref>). In summary, the downregulation of ADARB1 expression levels in LUSC tissues and cell lines suggested that ADARB1 may be a promising anti-oncogene in LUSC.</p>
</sec>
<sec>
<title>ADARB1 could be used for the identification of LUSC and LUAD</title>
<p>The results of the IHC analysis further suggested that ADARB1 was downregulated in LUAD tissues compared with normal lung tissues, which was consistent with our previous study (P=0.024; <xref rid="f2-mmr-21-03-1517" ref-type="fig">Fig. 2A and B</xref>) (<xref rid="b31-mmr-21-03-1517" ref-type="bibr">31</xref>). Furthermore, ADARB1 expression levels were significantly lower in LUSC tissues than in LUAD tissues (P=0.025; <xref rid="f2-mmr-21-03-1517" ref-type="fig">Fig. 2A and B</xref>). Subsequently, the GSE10245 dataset, obtained from GEO, suggested that ADARB1 was expressed at a lower level in LUSC compared with LUAD (P=0.031; <xref rid="f3-mmr-21-03-1517" ref-type="fig">Fig. 3A</xref>). Furthermore, this significant difference was verified by the CCLE database (P=0.008; <xref rid="f3-mmr-21-03-1517" ref-type="fig">Fig. 3B</xref>). Therefore, these results suggested that ADARB1 expression profiles may serve as indicators for the clinical diagnosis of LUSC and LUAD.</p>
</sec>
<sec>
<title>Relationship between ADARB1 expression and the clinical characteristics of patients with LUSC</title>
<p>The effects of ADARB1 expression on the clinical characteristics of patients with LUSC were examined. Clinical data were downloaded from the Wanderer database, and the clinical characteristic parameters are summarized in <xref rid="tI-mmr-21-03-1517" ref-type="table">Table I</xref>. The expression of ADARB1 was significantly associated with the pathologic N stage (P=0.045), pathologic M stage (P=0.012) and tobacco smoking history indicator (P=0.008). Furthermore, multivariate analysis of the clinical data suggested that the pathologic N stage (P=0.020), pathologic M stage (P=0.003) and tobacco smoking history indicator (P=0.017) were independently associated with ADARB1 expression in patients with LUSC (<xref rid="tII-mmr-21-03-1517" ref-type="table">Table II</xref>).</p>
</sec>
<sec>
<title>ADARB1 methylation is related to the clinical characteristics of patients with LUSC</title>
<p>The ADARB1 global methylation levels in LUSC were evaluated using the DiseaseMeth database. ADARB1 displayed significantly higher levels of methylation in LUSC samples compared with in normal lung samples (P=1.62&#x00D7;10<sup>&#x2212;12</sup>; <xref rid="f4-mmr-21-03-1517" ref-type="fig">Fig. 4A</xref>). The highest methylation value of cg24063645 in ADARB1 was identified using the Wanderer and MethSurv databases (P=3.60&#x00D7;10<sup>&#x2212;19</sup>; <xref rid="f4-mmr-21-03-1517" ref-type="fig">Fig. 4B</xref>; <xref rid="SD1-mmr-21-03-1517" ref-type="supplementary-material">Table SII</xref>). Subsequently, the association between cg24063645 methylation and the clinical characteristics of patients with LUSC was analyzed. The methylation of cg24063645 of ADARB1 was significantly associated with the Karnofsky score of patients with LUSC (P=0.025; <xref rid="tIII-mmr-21-03-1517" ref-type="table">Table III</xref>). Moreover, higher methylation levels of cg24063645 of ADARB1 were associated with shorter OS of patients with LUSC (P=0.044; <xref rid="f4-mmr-21-03-1517" ref-type="fig">Fig. 4C</xref>). Therefore, the results suggested that ADARB1 methylation levels may serve a role in the prognosis of patients with LUSC.</p>
</sec>
<sec>
<title>ADARB1 expression is negatively correlated with EGFR expression in LUSC tissues</title>
<p>EGFR is an oncogenic driver that contributes to the activation and development of lung cancer (<xref rid="b7-mmr-21-03-1517" ref-type="bibr">7</xref>). Previous studies have indicated a poor correlation between EGFR expression and the overall response rate in lung cancer, particularly in LUSC (<xref rid="b7-mmr-21-03-1517" ref-type="bibr">7</xref>,<xref rid="b32-mmr-21-03-1517" ref-type="bibr">32</xref>,<xref rid="b33-mmr-21-03-1517" ref-type="bibr">33</xref>). The GEPIA database was employed to evaluate the relationship between ADARB1 and EGFR. A negative correlation between ADARB1 and EGFR transcript levels in tissues of patients with LUSC was identified (P=7.80&#x00D7;10<sup>&#x2212;6</sup>; R=&#x2212;0.16; <xref rid="f5-mmr-21-03-1517" ref-type="fig">Fig. 5</xref>), which suggested that ADARB1 acted as an anti-cancer gene and might be linked to EGFR.</p>
</sec>
<sec>
<title>Network analysis of genes co-expressed with ADARB1</title>
<p>To further investigate the biological function of ADARB1, a functional enrichment analysis of its associated co-expressed genes was conducted. Firstly, 14,102 genes co-expressed with ADARB1 in LUSC were identified using the cBioPortal database, and a volcano plot was generated to display the association between groups with altered and unaltered ADARB1 expression (<xref rid="f6-mmr-21-03-1517" ref-type="fig">Fig. 6A</xref>). Based on the criteria of |log ratio|&#x003E;0.3 and P&#x003C;0.05, 158 ADARB1-associated, co-differentially expressed genes (co-DEGs) were identified (<xref rid="SD1-mmr-21-03-1517" ref-type="supplementary-material">Table SIII</xref>). A protein-protein interaction network was generated using the STRING database and Cytoscape software (<xref rid="f6-mmr-21-03-1517" ref-type="fig">Fig. 6B</xref>). Moreover, WebGestalt was used to analyze GO terms (<xref rid="f6-mmr-21-03-1517" ref-type="fig">Fig. 6C</xref>) and indicated that the main biological processes of the co-DEGs were primarily enriched in &#x2018;metabolic process&#x2019; and &#x2018;biological regulation&#x2019;. Moreover, Gan <italic>et al</italic> (<xref rid="b34-mmr-21-03-1517" ref-type="bibr">34</xref>) reported that ADARB1 participated in the regulation of pancreatic islet and &#x03B2;-cell function. Furthermore, deficient or hyperactive ADARB1 expression is associated with a number of human diseases, including immunological disorders, amyotrophic lateral sclerosis, epilepsy and cancer (<xref rid="b35-mmr-21-03-1517" ref-type="bibr">35</xref>). Therefore, it was speculated that ADARB1 might serve a role in LUSC via metabolic processes and biological regulation. In addition, for cellular components and molecular functions, the co-DEGs were primarily enriched in &#x2018;nucleus&#x2019; and &#x2018;protein binding&#x2019;, respectively. Finally, KEGG pathway enrichment was analyzed using the DAVID database, and &#x2018;ubiquitin mediated proteolysis&#x2019; and &#x2018;Wnt signaling pathway&#x2019; were identified as significantly enriched pathways related to ADARB1 expression (<xref rid="SD1-mmr-21-03-1517" ref-type="supplementary-material">Table SIV</xref>).</p>
</sec>
</sec>
</sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>The present study was conducted to evaluate the use of ADARB1 as a potential biomarker for patients with LUSC. To the best of our knowledge, the present study was the first to use bioinformatics methods to suggest that ADARB1 was downregulated in LUSC tissues and cell lines. Moreover, the expression of ADARB1 in LUSC was significantly different to that in LUAD. In addition, the global methylation levels of ADARB1 were upregulated in LUSC and a higher methylation value of cg24063645 was related to a shorter OS in patients with LUSC.</p>
<p>A-to-I RNA editing is a post-transcriptional modification mediated by the ADAR family, which is comprised of three members, ADAR1, ADARB1 and ADAR3 (<xref rid="b36-mmr-21-03-1517" ref-type="bibr">36</xref>,<xref rid="b37-mmr-21-03-1517" ref-type="bibr">37</xref>). The expression levels of ADARB1 determine the RNA editing activity at a number of A-to-I sites, which are involved in several diseases, including amyotrophic lateral sclerosis, autism and Fragile-X Syndrome (<xref rid="b38-mmr-21-03-1517" ref-type="bibr">38</xref>). Recently, several studies have indicated that ADARB1 participates in tumorigenesis as a cancer suppressor gene, which is consistent with the results of the present study. By analyzing the influence of A-to-I RNA modification on cancer progression, Fritzell <italic>et al</italic> (<xref rid="b39-mmr-21-03-1517" ref-type="bibr">39</xref>) reported that ADARB1 was expressed at low levels in glioblastoma, indicating that ADARB1 downregulation could induce malignant phenotypes. Additionally, using next-generation sequencing transcriptomics, Chan <italic>et al</italic> (<xref rid="b40-mmr-21-03-1517" ref-type="bibr">40</xref>) reported that ADARB1 contributed to inhibitory mechanisms in gastric cancer via its catalytic deaminase. However, Altadill <italic>et al</italic> (<xref rid="b41-mmr-21-03-1517" ref-type="bibr">41</xref>) demonstrated that ADARB1 was upregulated in endometrial cancer, and the increased expression was positively associated with disease aggression, suggesting that ADARB1 functions as an oncogene in endometrial cancer. The inconsistency between the observations of these aforementioned studies and the present study may be due to the diverse pathological states of different diseases; therefore, further investigation is required.</p>
<p>ADARB1 is a therapeutic target in a number of human diseases. Uchida <italic>et al</italic> (<xref rid="b42-mmr-21-03-1517" ref-type="bibr">42</xref>) reported a significant increase in ADAR2-dependent A-to-I editing at the glutamate ionotropic receptor AMPA type subunit R/G, 5-hydroxytryptamine 2c receptor D and COPI coat complex-&#x03B1; I/V sites, which suggested that ADARB1 was a regulator of neuropathic pain after peripheral nerve injury and could be used as a target for the treatment of neuropathic pain. In addition, Galeano <italic>et al</italic> (<xref rid="b43-mmr-21-03-1517" ref-type="bibr">43</xref>) reported that ADARB1 could inhibit glioblastoma growth by the regulation of the cell division cycle 14B/S-phase kinase associated protein 2/p21/p27 axis; therefore, ADARB1 or its substrates represented suitable targets for the treatment of glioblastoma. In the present study, ADARB1 was significantly downregulated in LUSC and was associated with clinical characteristics of patients with LUSC. Furthermore, the hypermethylation of ADARB1 was related to the poor prognosis of patients with LUSC. Therefore, it was speculated that ADARB1 may represent a potential target for the treatment of LUSC; however, this requires further investigation.</p>
<p>LUSC and LUAD are the two main subtypes of NSCLC, and the accurate differentiation of LUSC and LUAD is important for therapy stratification (<xref rid="b44-mmr-21-03-1517" ref-type="bibr">44</xref>). Although p40 is regarded as the gold standard for the differentiation of LUSC and LUAD by the World Health Organization and the European Society for Medical Oncology (<xref rid="b45-mmr-21-03-1517" ref-type="bibr">45</xref>&#x2013;<xref rid="b47-mmr-21-03-1517" ref-type="bibr">47</xref>), the identification of further biomarkers is required for distinguishing LUSC from LUAD. At present, numerous immune markers have been reported for the differentiation of LUSC and LUAD, including NK2 homeobox 1, napsin A, keratin 5 and p63. Kriegsmann <italic>et al</italic> and van Zyl <italic>et al</italic> (<xref rid="b48-mmr-21-03-1517" ref-type="bibr">48</xref>,<xref rid="b49-mmr-21-03-1517" ref-type="bibr">49</xref>) reported that all four aforementioned markers were differentially expressed in LUSC and LUAD, and could therefore be used as biomarkers for the two cancer subtypes. By immunohistochemistry and western blotting, Wang <italic>et al</italic> (<xref rid="b50-mmr-21-03-1517" ref-type="bibr">50</xref>) reported that the expression of the transcriptional co-factor tafazzin was associated with subtypes of LUSC and LUAD. Additionally, spermatogenesis associated serine rich 2, which is highly expressed in both LUSC and LUAD, displayed significantly higher expression in LUSC than LUAD, and thus, could be used as a marker to discriminate between the two subtypes (<xref rid="b51-mmr-21-03-1517" ref-type="bibr">51</xref>,<xref rid="b52-mmr-21-03-1517" ref-type="bibr">52</xref>). Similarly, in the present study, ADARB1 expression was significantly higher in LUAD tissues and cell lines compared with in LUSC tissues. Therefore, the present study suggested that ADARB1 might be used to distinguish between LUSC and LUAD.</p>
<p>EGFR has been demonstrated to be a driving factor in various types of cancer. A previous study indicated that, following phosphorylation on a regulatory tyrosine, EGFR can be activated in a ligand-dependent or -independent manner to induce tumor progression (<xref rid="b53-mmr-21-03-1517" ref-type="bibr">53</xref>). Additionally, EGFR has been reported to be upregulated in a number of different types of cancer and has been associated with cancer metastasis, drug resistance, poor prognosis and lower survival rates (<xref rid="b54-mmr-21-03-1517" ref-type="bibr">54</xref>). Moreover, the combination of aberrantly expressed EGFR and transforming growth factor (TGF)-&#x03B1; secretion by NSCLC cells can form a TGF-&#x03B1;-EGFR autocrine ring, which promotes tumor development (<xref rid="b55-mmr-21-03-1517" ref-type="bibr">55</xref>,<xref rid="b56-mmr-21-03-1517" ref-type="bibr">56</xref>). EGFR can also activate the downstream PI3K/Akt/mTOR signaling pathway, leading to cell growth and proliferation during NSCLC (<xref rid="b57-mmr-21-03-1517" ref-type="bibr">57</xref>). The present study identified a negative correlation between ADARB1 and EGFR expression in LUSC. Thus, it was hypothesized that ADARB1 could disturb the EGFR carcinogenic effect via metabolic processes and biological regulation in LUSC. This observation suggested that ADARB1 might act as an anti-oncogene by influencing EGFR expression; therefore, ADARB1 may be a useful molecular target for LUSC therapeutics.</p>
<p>In summary, the expression and role of ADARB1 in LUSC was investigated using a novel bioinformatics method. The results suggested that ADARB1 may be an anti-oncogene, and that it could be a promising biomarker in the tumorigenesis of LUSC and development of novel therapeutics for the disease. Therefore, understanding the function and mechanisms of ADARB1 in LUSC would provide a useful basis for the diagnosis and treatment of LUSC.</p>
</sec>
<sec sec-type="supplementary-material">
<title>Supplementary Material</title>
<supplementary-material id="SD1-mmr-21-03-1517" content-type="local-data">
<caption>
<title>Supporting Data</title>
</caption>
<media mimetype="application" mime-subtype="pdf" xlink:href="Supplementary_data.pdf"/>
</supplementary-material>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>Not applicable.</p>
</ack>
<sec>
<title>Funding</title>
<p>The present study was supported by grants from the National Natural Science Foundation of China (grant nos. 81703036, 81803035 and 81572946), the Fundamental Research Funds for the Central Universities of Central South University (grant no. 2019zzts345), the China Postdoctoral Science Foundation (grant no. 2017M610510) and the Youth Fund of Xiangya Hospital (grant no. 2017Q17).</p>
</sec>
<sec>
<title>Availability of data and materials</title>
<p>The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.</p>
</sec>
<sec>
<title>Authors&#x0027; contributions</title>
<p>ZX, YY and ZG conceived and designed the study. XW, YY and ZX developed the methodology. XR, XW and WL acquired the data. ZX, XW, YY, XC and JW analyzed and interpreted the data. XW, XR and ZX wrote, reviewed and revised the manuscript.</p>
</sec>
<sec>
<title>Ethics approval and consent to participate</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Patient consent for publication</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Competing interests</title>
<p>The authors declare that they have no competing interests.</p>
</sec>
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<fig id="f1-mmr-21-03-1517" position="float">
<label>Figure 1.</label>
<caption><p>Downregulation of ADARB1 in LUSC tissues and cell lines, as indicated by several databases. The expression of ADARB1 was analyzed by the (A) Genome Mining, (B) Cancer Cell Line Encyclopedia, (C) Oncomine, (D) University of Alabama Cancer Database and (E) Gene Expression Profiling Interactive Analysis databases. ADARB1, adenosine deaminase RNA specific B1; LUSC, lung squamous cell carcinoma; TPM, transcripts per million.</p></caption>
<graphic xlink:href="MMR-21-03-1517-g00.tif"/>
</fig>
<fig id="f2-mmr-21-03-1517" position="float">
<label>Figure 2.</label>
<caption><p>Downregulation of ADARB1 in the lung cancer tissue array. (A) Immunohistochemistry was used to examine the level of ADARB1 expression in a commercial lung cancer tissue array. (B) Protein levels of ADARB1 were significantly downregulated in the lung tissue of patients with LUSC or LUAD compared with normal lung tissue. ADARB1 expression was significantly decreased in LUSC tissues compared with LUAD tissue samples. ADARB1, adenosine deaminase RNA specific B1; LUAD, lung adenocarcinoma; LUSC, lung squamous cell carcinoma.</p></caption>
<graphic xlink:href="MMR-21-03-1517-g01.tif"/>
</fig>
<fig id="f3-mmr-21-03-1517" position="float">
<label>Figure 3.</label>
<caption><p>ADARB1 expression is significantly different between LUSC and LUAD. (A) Dataset GSE10245, obtained from Gene Expression Omnibus, suggested that ADARB1 was expressed at a lower level in LUSC compared with LUAD. (B) Difference in ADARB1 expression in LUSC and LUAD cell lines, as determined by Cancer Cell Line Encyclopedia analysis. ADARB1, adenosine deaminase RNA specific B1; LUAD, lung adenocarcinoma; LUSC, lung squamous cell carcinoma.</p></caption>
<graphic xlink:href="MMR-21-03-1517-g02.tif"/>
</fig>
<fig id="f4-mmr-21-03-1517" position="float">
<label>Figure 4.</label>
<caption><p>Methylation values of ADARB1 in patients with LUSC. (A) Global methylation of ADARB1 in LUSC samples compared with normal samples, using DiseaseMeth. (B) Heat map () acquired from MethSurv described the methylation sites of ADARB1 in LUSC. Red represents upregulation and blue represents downregulation. (C) Relationship between methylation values of cg24063645 of ADARB1 and overall survival time in LUSC. ADARB1, adenosine deaminase RNA specific B1; HR, hazard risk; LR, log rank; LUSC, lung squamous cell carcinoma.</p></caption>
<graphic xlink:href="MMR-21-03-1517-g03.tif"/>
</fig>
<fig id="f5-mmr-21-03-1517" position="float">
<label>Figure 5.</label>
<caption><p>ADARB1 expression is negatively correlated with EGFR expression in LUSC. The Gene Expression Profiling Interactive Analysis database identified an association between the transcript levels of ADARB1 and EGFR in tissues derived from patients with LUSC. ADARB1, adenosine deaminase RNA specific B1; EGFR, epidermal growth factor receptor; LUSC, lung squamous cell carcinoma; TPM, transcripts per million.</p></caption>
<graphic xlink:href="MMR-21-03-1517-g04.tif"/>
</fig>
<fig id="f6-mmr-21-03-1517" position="float">
<label>Figure 6.</label>
<caption><p>Functional enrichment analysis of ADARB1-associated co-DEGs in LUSC samples. (A) Volcano plot displayed the genes co-expressed with ADARB1 in LUSC (red represents upregulation, green represents downregulation and black is no change). (B) A protein-protein interaction network of ADARB1-associated co-DEGs was generated using the Search Tool for the Retrieval of Interacting Genes/Proteins database and Cytoscape software (square nodes represent hub genes, round nodes represent co-expression genes; the color represents the degree score; degree score &#x003C;0.5 represent low values (colored yellow), degree score &#x2265;0.5 represent high values (other colors). (C) Gene Ontology analysis of ADARB1-associated co-DEGs. ADARB1, adenosine deaminase RNA specific B1; co-DEGs, co-differentially expressed genes; LUSC, lung squamous cell carcinoma.</p></caption>
<graphic xlink:href="MMR-21-03-1517-g05.tif"/>
</fig>
<table-wrap id="tI-mmr-21-03-1517" position="float">
<label>Table I.</label>
<caption><p>Association between clinical characteristic parameters and the expression of adenosine deaminase RNA specific B1 in lung squamous cell carcinoma.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom">Variable</th>
<th align="center" valign="bottom">n</th>
<th align="center" valign="bottom">Mean &#x00B1; SD</th>
<th align="center" valign="bottom">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Pathologic T</td>
<td/>
<td/>
<td align="center" valign="top">0.433</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T1/T1a/T1b</td>
<td align="center" valign="top">100</td>
<td align="center" valign="top">8.148&#x00B1;0.924</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T2/T2a/T2b</td>
<td align="center" valign="top">252</td>
<td align="center" valign="top">8.103&#x00B1;1.035</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T3</td>
<td align="center" valign="top">48</td>
<td align="center" valign="top">8.367&#x00B1;0.967</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T4</td>
<td align="center" valign="top">19</td>
<td align="center" valign="top">8.155&#x00B1;1.232</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Pathologic N</td>
<td/>
<td/>
<td align="center" valign="top"><bold>0.045</bold></td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N0</td>
<td align="center" valign="top">262</td>
<td align="center" valign="top">8.134&#x00B1;1.008</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N1</td>
<td align="center" valign="top">111</td>
<td align="center" valign="top">8.236&#x00B1;0.955</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N2</td>
<td align="center" valign="top">5</td>
<td align="center" valign="top">7.533&#x00B1;1.031</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N3</td>
<td align="center" valign="top">6</td>
<td align="center" valign="top">9.050&#x00B1;0.584</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Pathologic M</td>
<td/>
<td/>
<td align="center" valign="top"><bold>0.012</bold></td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;M0</td>
<td align="center" valign="top">357</td>
<td align="center" valign="top">8.113&#x00B1;0.996</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;M1/M1a</td>
<td align="center" valign="top">6</td>
<td align="center" valign="top">7.576&#x00B1;0.607</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;MX</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">8.511&#x00B1;1.081</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Pathologic tumor stage</td>
<td/>
<td/>
<td align="center" valign="top">0.078</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;I/IA/IB</td>
<td align="center" valign="top">211</td>
<td align="center" valign="top">8.116&#x00B1;0.985</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;IIA/IIB</td>
<td align="center" valign="top">123</td>
<td align="center" valign="top">8.315&#x00B1;0.981</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;IIIA/IIIB</td>
<td align="center" valign="top">76</td>
<td align="center" valign="top">8.013&#x00B1;1.122</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;IV</td>
<td align="center" valign="top">6</td>
<td align="center" valign="top">7.576&#x00B1;0.607</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Ethnicity</td>
<td/>
<td/>
<td align="center" valign="top">0.133</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;White</td>
<td align="center" valign="top">297</td>
<td align="center" valign="top">8.190&#x00B1;1.033</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Black/African American</td>
<td align="center" valign="top">16</td>
<td align="center" valign="top">8.208&#x00B1;0.809</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Asian</td>
<td align="center" valign="top">9</td>
<td align="center" valign="top">8.888&#x00B1;1.028</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Tobacco smoking history indicator</td>
<td/>
<td/>
<td align="center" valign="top"><bold>0.008</bold></td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Current reformed smoker for &#x003E;15 years</td>
<td align="center" valign="top">71</td>
<td align="center" valign="top">8.404&#x00B1;0.991</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Current reformed smoker for &#x2264;15 years</td>
<td align="center" valign="top">211</td>
<td align="center" valign="top">8.018&#x00B1;1.007</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Current reformed smoker, duration not specified</td>
<td align="center" valign="top">1</td>
<td align="center" valign="top">9.922&#x00B1;0.000</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Lifelong non-smoker</td>
<td align="center" valign="top">17</td>
<td align="center" valign="top">8.533&#x00B1;1.042</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Current smoker</td>
<td align="center" valign="top">112</td>
<td align="center" valign="top">8.137&#x00B1;0.977</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Age</td>
<td/>
<td/>
<td align="center" valign="top">0.857</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;&#x2264;60 years</td>
<td align="center" valign="top">89</td>
<td align="center" valign="top">8.133&#x00B1;1.093</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;&#x003E;60 years</td>
<td align="center" valign="top">322</td>
<td align="center" valign="top">8.155&#x00B1;0.994</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Karnofsky score</td>
<td/>
<td/>
<td align="center" valign="top">0.236</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;0-70</td>
<td align="center" valign="top">47</td>
<td align="center" valign="top">7.939&#x00B1;1.233</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;80</td>
<td align="center" valign="top">14</td>
<td align="center" valign="top">7.910&#x00B1;0.884</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;90</td>
<td align="center" valign="top">22</td>
<td align="center" valign="top">8.173&#x00B1;0.948</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;100</td>
<td align="center" valign="top">10</td>
<td align="center" valign="top">8.687&#x00B1;0.957</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Eastern Cooperative Oncology Group score</td>
<td/>
<td/>
<td align="center" valign="top">0.079</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;0</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">8.470&#x00B1;1.099</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;1</td>
<td align="center" valign="top">71</td>
<td align="center" valign="top">8.208&#x00B1;0.978</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;2</td>
<td align="center" valign="top">20</td>
<td align="center" valign="top">8.007&#x00B1;1.061</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;3</td>
<td align="center" valign="top">3</td>
<td align="center" valign="top">7.211&#x00B1;0.597</td>
<td/>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1-mmr-21-03-1517"><p>Values in bold are significant.</p></fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tII-mmr-21-03-1517" position="float">
<label>Table II.</label>
<caption><p>Multivariate analysis of clinical data related to adenosine deaminase RNA specific B1 expression in lung squamous cell carcinoma.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom">Characteristic</th>
<th align="center" valign="bottom">Type III sum of squares</th>
<th align="center" valign="bottom">Degrees of freedom</th>
<th align="center" valign="bottom">Mean square</th>
<th align="center" valign="bottom">F-value</th>
<th align="center" valign="bottom">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Pathologic N</td>
<td align="center" valign="top">11.32</td>
<td align="center" valign="top">4</td>
<td align="center" valign="top">2.83</td>
<td align="center" valign="top">2.96</td>
<td align="center" valign="top">0.020</td>
</tr>
<tr>
<td align="left" valign="top">Pathologic M</td>
<td align="center" valign="top">11.50</td>
<td align="center" valign="top">2</td>
<td align="center" valign="top">5.75</td>
<td align="center" valign="top">6.02</td>
<td align="center" valign="top">0.003</td>
</tr>
<tr>
<td align="left" valign="top">Tobacco smoking history indicator</td>
<td align="center" valign="top">&#x00A0;&#x00A0;9.88</td>
<td align="center" valign="top">3</td>
<td align="center" valign="top">3.30</td>
<td align="center" valign="top">3.45</td>
<td align="center" valign="top">0.017</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tIII-mmr-21-03-1517" position="float">
<label>Table III.</label>
<caption><p>Association between the clinical characteristics and methylation site value of cg24063645 of adenosine deaminase RNA specific B1 in patients with lung squamous cell carcinoma.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom">Variable</th>
<th align="center" valign="bottom">n</th>
<th align="center" valign="bottom">Mean &#x00B1; SD</th>
<th align="center" valign="bottom">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Sex</td>
<td/>
<td/>
<td align="center" valign="top">0.717</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Male</td>
<td align="center" valign="top">215</td>
<td align="center" valign="top">0.983&#x00B1;0.042</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Female</td>
<td align="center" valign="top">&#x00A0;&#x00A0;73</td>
<td align="center" valign="top">0.985&#x00B1;0.021</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">KRAS gene analysis indicator</td>
<td/>
<td/>
<td align="center" valign="top">0.760</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Yes</td>
<td align="center" valign="top">&#x00A0;&#x00A0;6</td>
<td align="center" valign="top">0.988&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;No</td>
<td align="center" valign="top">197</td>
<td align="center" valign="top">0.983&#x00B1;0.038</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">EGFR mutation status</td>
<td/>
<td/>
<td align="center" valign="top">0.682</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Yes</td>
<td align="center" valign="top">&#x00A0;&#x00A0;15</td>
<td align="center" valign="top">0.987&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;No</td>
<td align="center" valign="top">174</td>
<td align="center" valign="top">0.983&#x00B1;0.040</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Treatment outcome: First course</td>
<td/>
<td/>
<td align="center" valign="top">0.718</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Complete remission/response</td>
<td align="center" valign="top">&#x00A0;&#x00A0;55</td>
<td align="center" valign="top">0.983&#x00B1;0.022</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Stable disease</td>
<td align="center" valign="top">&#x00A0;&#x00A0;2</td>
<td align="center" valign="top">0.989&#x00B1;0.001</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Pathologic T</td>
<td/>
<td/>
<td align="center" valign="top">0.562</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T1/T1a/T1b</td>
<td align="center" valign="top">&#x00A0;&#x00A0;76</td>
<td align="center" valign="top">0.986&#x00B1;0.009</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T2/T2a/T2b</td>
<td align="center" valign="top">166</td>
<td align="center" valign="top">0.980&#x00B1;0.049</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T3</td>
<td align="center" valign="top">&#x00A0;&#x00A0;37</td>
<td align="center" valign="top">0.987&#x00B1;0.004</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;T4</td>
<td align="center" valign="top">&#x00A0;&#x00A0;9</td>
<td align="center" valign="top">0.988&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Pathologic N</td>
<td/>
<td/>
<td align="center" valign="top">0.117</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N0</td>
<td align="center" valign="top">179</td>
<td align="center" valign="top">0.984&#x00B1;0.029</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N1</td>
<td align="center" valign="top">&#x00A0;&#x00A0;79</td>
<td align="center" valign="top">0.985&#x00B1;0.014</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;N2</td>
<td align="center" valign="top">&#x00A0;&#x00A0;24</td>
<td align="center" valign="top">0.967&#x00B1;0.099</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;NX</td>
<td align="center" valign="top">&#x00A0;&#x00A0;6</td>
<td align="center" valign="top">0.984&#x00B1;0.004</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Pathologic M</td>
<td/>
<td/>
<td align="center" valign="top">0.861</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;M0</td>
<td align="center" valign="top">233</td>
<td align="center" valign="top">0.984&#x00B1;0.035</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;M1/M1a</td>
<td align="center" valign="top">&#x00A0;&#x00A0;3</td>
<td align="center" valign="top">0.988&#x00B1;0.003</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;MX</td>
<td align="center" valign="top">&#x00A0;&#x00A0;50</td>
<td align="center" valign="top">0.986&#x00B1;0.004</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Tumor stage</td>
<td/>
<td/>
<td align="center" valign="top">0.919</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;I/IA/IB</td>
<td align="center" valign="top">141</td>
<td align="center" valign="top">0.986&#x00B1;0.015</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;IIA/IIB</td>
<td align="center" valign="top">&#x00A0;&#x00A0;96</td>
<td align="center" valign="top">0.986&#x00B1;0.013</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;IIIA/IIIB</td>
<td align="center" valign="top">&#x00A0;&#x00A0;46</td>
<td align="center" valign="top">0.976&#x00B1;0.072</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;IV</td>
<td align="center" valign="top">&#x00A0;&#x00A0;3</td>
<td align="center" valign="top">0.988&#x00B1;0.003</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Ethnicity</td>
<td/>
<td/>
<td align="center" valign="top">0.878</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;White</td>
<td align="center" valign="top">224</td>
<td align="center" valign="top">0.984&#x00B1;0.028</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Black/African American</td>
<td align="center" valign="top">&#x00A0;&#x00A0;10</td>
<td align="center" valign="top">0.988&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;Asian</td>
<td align="center" valign="top">&#x00A0;&#x00A0;7</td>
<td align="center" valign="top">0.988&#x00B1;0.003</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Karnofsky score</td>
<td/>
<td/>
<td align="center" valign="top"><bold>0.025</bold></td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;0-70</td>
<td align="center" valign="top">&#x00A0;&#x00A0;29</td>
<td align="center" valign="top">0.988&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;80</td>
<td align="center" valign="top">&#x00A0;&#x00A0;14</td>
<td align="center" valign="top">0.987&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;90</td>
<td align="center" valign="top">&#x00A0;&#x00A0;18</td>
<td align="center" valign="top">0.985&#x00B1;0.004</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;100</td>
<td align="center" valign="top">&#x00A0;&#x00A0;9</td>
<td align="center" valign="top">0.987&#x00B1;0.002</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Age</td>
<td/>
<td/>
<td align="center" valign="top">0.341</td>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;&#x2264;60 years</td>
<td align="center" valign="top">&#x00A0;&#x00A0;59</td>
<td align="center" valign="top">0.987&#x00B1;0.003</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">&#x00A0;&#x00A0;&#x003E;60 years</td>
<td align="center" valign="top">221</td>
<td align="center" valign="top">0.982&#x00B1;0.043</td>
<td/>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn2-mmr-21-03-1517"><p>Values in bold are significant. EGFR, epidermal growth factor receptor.</p></fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</article>