Prognostic implications of P-glycoprotein, epidermal growth factor receptor and transforming growth factor alpha

The prognostic value of clinical and pathological factors in 97 patients (pts) with non-small cell lung cancer (NSCLC), were analyzed through immunohistochemical methods. The impact on response rate and survival of age, Karnofsky performance status (PS), sex, NSCLC subtype and grade, extent of disease, objective chemotherapy response, LDH values, metastatic sites involved and immunohistochemical study of epidermal growth factor receptor (EGF-r), transforming growth factor alpha (TGF-alpha) and P-glycoprotein (Pgp) employing two monoclonal antibodies: C-219 and JSB-1, were analyzed. Median age was 61 years, seven pts were women. Histologically, 58 had squamous cell carcinoma, 28 adenocarcinoma and 11 large cell undifferentiated carcinoma. One patient had stage II, 35 stage IIIA, 19 stage IIIB and 42 stage IV. Six pts achieved complete response, 18 partial response, 34 stable disease and 39 progressive disease. EGF-r was positive in 30 cases, TGF-alpha in 51, C-219 Pgp in 13 and JSB-1 Pgp in 35 cases. The univariate analysis showed that 4 parameters had significant adverse effect on survival: non-responders, poor PS, abnormal LDH value and absence of EGF-r expression. On the other hand, we found no correlation between TOP-alpha and EGF-r immunostaining. But 22 pts expressed both autocrine markers and these pts had a worse median survival time. Multivariate analysis showed that the only independent prognostic factor in predicting survival was Karnofsky performance status.