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Prognostic Value of SOX9, E-Cadherin, and KLF4 Expressions in Clear Cell Renal Carcinoma
Seyma Ozturk1, Selma Erdogan Duzcu2
1Department of Pathology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkiye.
Objective:
To analyse the immunohistochemical staining of stem cell-related factors SOX9 and KLF4 in radical and partial nephrectomy specimens and to determine their relationship to grade, metastasis, stage, other prognostic parameters, and their predictive value.
Study Design:
Descriptive study. Place and Duration of the Study: Department of Pathology, Bolu Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkiye, from 2015 to 2022.
Methodology:
The study included 92 cases diagnosed with clear cell renal cell carcinoma (ccRCC) from sections and blocks of partial and radical nephrectomies. Formalin-fixed and paraffin-embedded blocks were sliced. A Leica Bond Max staining device stained SOX9, E-cadherin, and KLF4 onto the slides. Nuclear staining for SOX9 and KLF4 and membranous staining for E-cadherin were evaluated. Since E-cadherin loss has an important role in the development of malignancy, the E-cadherin staining pattern was considered when evaluating the staining patterns of SOX9 and KLF4. The Mann-Whitney U and Kruskal-Wallis tests were applied to compare immunohistochemical data with prognostic factors such as gender, tumour size, grade, metastasis, and stage. The statistical analyses were conducted using the IBM SPSS version 20, with a p-value of less than 0.05 considered as statistically significant.
Results:
Significant correlations were observed between SOX9, KLF4, and E-cadherin expression levels and high nuclear grade, with p-values of 0.005, <0.001, and 0.002, respectively. In addition, the overexpression of SOX9 was significantly linked to distant metastasis and stage, with p-values of 0.010 and 0.025, respectively.
Conclusion:
SOX9, E-cadherin, and KLF4 expressions are linked to unfavourable prognostic factors in ccRCC. Thus, these immunohistochemical stains may serve as potential biomarkers in this cancer and aid in identifying prognosis and treatment response.
Key Words:
Clear cell renal carcinoma, SOX9 transcription factor, E-cadherin, Kruppel-like transcription factors, Prognosis.
