Abstract
Objective: The study was to assess whether tumour expressions of hypoxia-inducible factor (HIF)-1α, glucose transporter (GLUT)-1, carbonic anhydrase (CA) IX and vascular endothelial growth factor (VEGF) predict response to neo-adjuvant chemotherapy (naCHT) in children with inoperable rhabdomyosarcoma (RMS). Methods: Immunohistochemical expressions of hypoxia markers were determined semi-quantitatively in tumour tissue microarray of 46 patients with embryonal RMS (RME) and 20 with alveolar (RMA), treated with CWS protocols (1992-2013). Results: In paediatric RME, response to naCHT was influenced significantly by tumour expression of CA IX and GLUT-1. Patients with RMA with low expressions of analysed markers responded well to naCHT, while all poor-responders expressed highly hypoxia markers. Only 5.88% of RMA and 11.11% of RME tumours did not express any of the proteins. In both RME and RMA subgroups, most poor-responders demonstrated simultaneous high expression of ≥3 markers, while most patients expressing ≤2 markers responded well to naCHT. In the whole cohort, co-expression of ≥3 markers, was the only independent factor predicting poor-response to chemotherapy (odds ratio 14.706; 95% CI 1.72-125.75; p = 0.014). Conclusions: Immunohistochemical expression pattern of four endogenous markers of hypoxia, in tumour tissue at diagnosis, emerges as a promising tool to predict response to naCHT in children with inoperable RMS.
Keywords:
CA IX; GLUT-1; HIF-1α; VEGF; children; response to neo-adjuvant chemotherapy; rhabdomyosarcoma.
MeSH terms
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Adolescent
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Antigens, Neoplasm / genetics*
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Antigens, Neoplasm / metabolism
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Biomarkers, Tumor / genetics*
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Biomarkers, Tumor / metabolism
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Biopsy
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Carbonic Anhydrase IX / genetics*
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Carbonic Anhydrase IX / metabolism
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Carboplatin / therapeutic use
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Chemotherapy, Adjuvant / methods
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Child
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Child, Preschool
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Dactinomycin / therapeutic use
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Epirubicin / therapeutic use
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Female
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Gene Expression
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Glucose Transporter Type 1 / genetics*
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Glucose Transporter Type 1 / metabolism
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Humans
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Hypoxia / diagnosis
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Hypoxia / drug therapy
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Hypoxia / genetics
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Hypoxia / mortality
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Hypoxia-Inducible Factor 1, alpha Subunit / genetics*
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Hypoxia-Inducible Factor 1, alpha Subunit / metabolism
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Ifosfamide / therapeutic use
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Infant
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Infant, Newborn
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Male
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Muscle Neoplasms / diagnosis
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Muscle Neoplasms / drug therapy*
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Muscle Neoplasms / genetics
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Muscle Neoplasms / mortality
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Neoadjuvant Therapy / methods
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Prognosis
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Prospective Studies
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Rhabdomyosarcoma, Alveolar / diagnosis
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Rhabdomyosarcoma, Alveolar / drug therapy*
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Rhabdomyosarcoma, Alveolar / genetics
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Rhabdomyosarcoma, Alveolar / mortality
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Rhabdomyosarcoma, Embryonal / diagnosis
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Rhabdomyosarcoma, Embryonal / drug therapy*
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Rhabdomyosarcoma, Embryonal / genetics
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Rhabdomyosarcoma, Embryonal / mortality
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Survival Analysis
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Treatment Outcome
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Vascular Endothelial Growth Factor A / genetics*
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Vascular Endothelial Growth Factor A / metabolism
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Vincristine / therapeutic use
Substances
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Antigens, Neoplasm
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Biomarkers, Tumor
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Glucose Transporter Type 1
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HIF1A protein, human
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Hypoxia-Inducible Factor 1, alpha Subunit
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SLC2A1 protein, human
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VEGFA protein, human
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Vascular Endothelial Growth Factor A
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Dactinomycin
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Epirubicin
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Vincristine
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Carboplatin
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CA9 protein, human
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Carbonic Anhydrase IX
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Ifosfamide