Vasculogenic mimicry and expression of Twist1 and KAI1 correlate with metastasis and prognosis in lung squamous cell carcinoma

Background: Vasculogenic mimicry (VM) is a new blood supply development often seen in highly aggressive cancers and has been considered as a usefully metastatic and prognostic factor for many cancers. Twist1 (a biomarker of epithelial-mesenchymal transition), and KAI1 (a suppressor of tumor metastasis) are both usefully predictive factors for metastasis in many cancers. However, the metastatic and prognostic value of VM, Twist1, or KAI1 in lung squamous cell carcinoma (LSCC) is unclear. In this study, we analyzed associations among VM, Twist1, and KAI1 in LSCC, and their respective associations with clinicopathological parameters and survival in LSCC.

Case presentation: Positive rates of VM, Twist1, and KAI1 in 157 whole LSCC tissue specimens were detected by immunohistochemistry and histochemical staining. Patient's clinical data were also collected. Levels of VM and Twist1 were significantly higher, and levels of KAI1 were significantly lower, in LSCC tissues than in normal lung tissues. Levels of VM and Twist1 were positively associated with tumor grade, lymph node metastasis (LNM), and tumor-node-metastasis (TNM) stage, and inversely with patients overall survival (OS) time; levels of KAI1 was negatively associated with tumor grade, LNM, and TNM stage, and the KAI1+ subgroup had significantly longer OS time than did the KAI1- subgroup. In multivariate analysis, high VM, or Twist1 levels, TNM stage, size of tumors, and low KAI1 levels were potential to be independent prognostic factors for OS time in patients with LSCC.

Conclusions: VM, and the expression of Twist1 and KAI1 represent promising markers for metastasis and prognosis, and potential therapeutic targets for LSCC.