Increase in the Frequency of p16 Gene Inactivation by Hypermethylation in Lung Cancer during the Process of Metastasis and Its Relation to the Status of p53

The p16 gene, which is a tumor suppressor gene, is frequently altered in lung cancers. Hypermethylation of the promoter region of the p16 gene seems to be the major mechanism through which p16 become inactivated. Hypermethylation of the p16 gene was reported to occur at an early stage in lung cancer. To determine whether the change in p16 methylation status occurs at the late stage in the progression of primary lung cancers, we analyzed the primary and metastatic tumor tissues and normal lung samples from 29 cases of advanced lung cancer with distant metastasis. In each tissue sample, we analyzed the p16 and p15 genes for mutations and the methylation status of both genes using PCR-single strand conformation polymorphism, direct sequencing, and methylation-specific PCR analysis. We also analyzed a subset of the samples for p16 protein expression. Genetic mutations in the coding region of the p16 and p15 genes were not found in any of the examined specimens. The promoter region of the p16 gene was hypermethylated in the tumor samples of the primary or metastatic site of 37.0% (10 of 27) of the subjects. The promoter region of the p16 gene was hypermethylated at both the primary and metastatic sites in two of the 10 cases and at only the metastatic site in 8 cases. By immunohistochemical analysis, we confirmed the presence of p16 protein at the primary site of all cases in which the promoter region of the p16 gene was hypermethylated at only the metastatic site. Interestingly, all 8 cases with a hypermethylated p16 promoter region, at only the metastatic site, did not have p53 mutation. The results of this study indicate that tumor cells in which the p16 gene has been inactivated by hypermethylation of the promoter region could have an advantage in progression and metastasis in non-small cell lung cancers, especially in the tumors with normal p53, and that the frequency of p16 gene inactivation by hypermethylation could vary in clinical course.