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Originally published as JCO Early Release 10.1200/JCO.2004.11.135 on July 26 2004 © 2004 American Society of Clinical Oncology. Promoter Methylation of Retinoic Acid Receptor Beta 2 and the Development of Second Primary Lung Cancers in NonSmall-Cell Lung CancerFrom the Center for Genome Research, Samsung Biomedical Research Institute; Division of Pulmonary and Critical Care Medicine, Department of Thoracic Surgery, and Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Molecular Cell Biology, Sungkyunkwan University, School of Medicine, Suwon, Korea Address reprint requests to Duk-Hwan Kim, MD, ScD, Center for Genome Research, Samsung Biomedical Research Institute, Rm B155, #50 Ilwon-dong, Kangnam-Ku, Seoul, Korea, 135-710; e-mail: dukhwan{at}samsung.co.kr PURPOSE: To investigate whether the promoter hypermethylation of retinoic acid receptor beta 2 (RARß2) is associated with the development of second primary lung cancers (SPLCs) differentially according to smoking status in primary nonsmall-cell lung cancer (NSCLC). PATIENTS AND METHODS: We retrospectively analyzed the relationship between RARß2 methylation and the SPLC development in a total of 342 NSCLCs. The methylation status of RARß2 was determined by using methylation-specific polymerase chain reaction. The difference in the time to SPLC development was analyzed by using the log-rank test and the Cox proportional hazards model. The median follow-up was 4.1 years. RESULTS: SPLCs developed in 19 (5.6%) of the 342 NSCLCs, and overall incidence rate of SPLC development was 1.54 per 100 patient-years. SPLCs did not occur in 39 patients who had not smoked. After controlling for possible confounding factors, the hazard of failure for former smokers with RARß2 hypermethylation was about 2.87 (95% CI, 0.92 to 13.64; P = .08) times higher compared to those without RARß2 methylation. However, for current smokers, hypermethylation of the RARß2 was found to have a protective effect against the SPLC development (hazard ratio = 0.23; 95% CI, 0.11 to 0.87; P = .03). CONCLUSION: Hypermethylation of RARß2 promoter had a differential effect on the development of SPLCs in NSCLC, and this was dependent on smoking status. Our study suggests that a combination of retinoids and/or a demethylating agent may be effective in the prevention of SPLCs in never-smokers and former smokers with NSCLC. Supported by grants from the Samsung Biomedical Research Institute and the Samsung Advanced Institute of Technology. Authors' disclosures of potential conflicts of interest are found at the end of this article.
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Copyright © 2004 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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