Relationship between the Endogenous Hypoxic Markers Hypoxia Inducible Factor-1 , Carbonic Anhydrase IX, and Epithelial Mesenchymal Transition Regulator TWIST Expression in Non-small Cell Lung Cancer

Background : The epithelial mesenchymal transition (EMT) is intimately associated with tumor hypoxia. The present study was conducted to investigate the immunohistochemical relationship between hypoxic and EMT-related molecules in non-small cell lung carcinoma (NSCLC). Methods : Immunohistochemical staining for hypoxia inducible factor (HIF)-1a, carbonic anhydrase (CA) IX, TWIST, and E-cadherin proteins was performed in 146 cases of NSCLC (80 cases of adenocarcinoma and 66 cases of squamous cell carcinoma) using tissue microarray blocks. Results : HIF-1a, TWIST, CA IX, and E-cadherin were expressed in 58 (40%), 90 (62%), 82 (56%), and 36 (25%) of 146 NSCLC cases, respectively. TWIST expression was positively correlated with HIF-1a expression (p = 0.03) and inversely correlated with E-cadherin expression (p < 0.01). TWIST and CA IX expression were not significantly interrelated, but each showed a relationship with histological tumor grade. However, the expression of these molecules had no significant effect on clinical staging or patient survival. Conclusions : Although TWIST expression was correlated positively with HIF-1a expression and inversely correlated with E-cadherin, HIF-1a expression was not associated with E-cadherin expression. However, considering the relationship between HIF-1a and TWIST expression, further studies should be performed to demonstrate the role of hypoxia-induced EMT in NSCLC.