A close relationship between HIF-1α expression and bone metastases in advanced NSCLC, a retrospective analysis

Background: Hypoxia-inducible factor (HIF-1) is a transcription factor produced in hypoxia condition, it is closely associated with tumor angiogenesis and metastasis. Aim: To investigate the expression of HIF-1α in relation with the presence or absence of bone metastasis. Methods A retrospective analysis was carried out on samples deriving from bronchial biopsy and CT-guided trans-thoracic needle biopsy. Detection of HIF-1 expression was performed on tissue sample by a monoclonal murine antibody, comparing patients with or without bone metastases (BM+). Findings: In the total population the main histotype was adenocarcinoma (71.5%), COPD the prevalent comorbidity (73.6%), the mean pack-year was 36.4. Ninety-five histology samples were considered for analysis and comparison. Subdividing the population according to the presence or not of bone metastases, significant differences were found in pack-years (p = 0.02), time to progression (TTP) (p = 0.001) and COPD comorbidity (p = 0.04). The survival comparison between the two subgroups obtained by Kaplan-Meier method showed a longer TTP in patients with visceral metastases with a HR of 1.3 though the comparison by this method was not significant (p = 0.1). A higher intensity and percentage of expression of HIF-1α was recorded in the group with bone metastases (p = 0.02). The main variable affecting HIF expression in a multivariate analysis was the presence of bone metastases (p = 0.01). Interpretation: Patients affected by NSCLC IV stage with bone metastasis have lower survival. There is a very close link between bone metastasis and HIF-1α expression level. The latter could be considered a predictive factor of bone spread and poor prognosis.