The impact of immunohistochemical expression of nitric oxide synthases on clinical and pathological features of renal cell carcinoma

• Published in: World journal of urology Vol. 31; no. 5; pp. 1197 - 1203
• Main Authors: Cássio Zequi, Stênio de, Fregnani, José Humberto G. T., Favaretto, Ricardo L., Costa, Walter H., Madeira Campos, Rodrigo S., Fonseca, Francisco P., Guimaraes, Gustavo C., Soares, Fernando A., da Cunha, Isabela W., Lopes, Ademar
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2013; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Renal Cell - metabolism; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Female; Humans; Immunohistochemistry; Kidney - metabolism; Kidney - pathology; Kidney - surgery; Kidney Neoplasms - metabolism; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Nephrectomy; Nephrology; Nitric Oxide Synthase Type I - metabolism; Nitric Oxide Synthase Type II - metabolism; Nitric Oxide Synthase Type III - metabolism; Oncology; Original Article; Prognosis; Retrospective Studies; Survival Rate; Treatment Outcome; Urology; Immunohistochemistry; Nitric oxide synthase; Renal cell carcinoma; NOS 3; Survival; Prognostic
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-012-0878-1

Purpose
To evaluate the immunohistochemical expression of nitric oxide synthase (NOS) types 1, 2, and 3 in intratumoral and non-neoplastic samples of renal cell carcinoma (RCC) and correlate it with the clinical and pathological features of this malignancy.
Methods
We analyzed 110 patients with RCC underwent radical nephrectomy (RN) or partial nephrectomy (PN) by streptavidin–biotin peroxidase method, tissue microarray, and digital microscopy. As endpoints, NOS expression was correlated with pathological features, overall survival (OS), and cancer-specific survival (CSS).
Results
Non-neoplastic samples had higher NOS3 and lower NOS 2 levels than RCC tissues. Greater expression of all NOS isoforms was associated with larger tumors. High NOS1 expression correlated with microscopic venous invasion (MVI) (
p
 = 0.046) and lymph node metastases (
p
 = 0.007). High NOS2 expression was linked to MVI, more RN performed, and male gender (
p
 = 0.035,
p
 = 0.003, and
p
 =  0.027, respectively). High NOS3 expression correlated with lymph node metastases (
p
 = 0.039), microlymphatic invasion (
p
 = 0.029), invasion of the renal pelvis and ureter (
p
 = 0.004), RN (
p
 = 0.003), and shorter OS (58.1 vs. 79.4 % respectively,
p
 = 0.033) by univariate analysis. DFS was not influenced by any NOS isoform. By multivariate analysis, the risk factors for death were TNM stages III and IV (hazard ratio [HR] = 4.5), high Fuhrman’s grade (HR = 2.9), Karnofsky performance status ≤80 (HR = 2.5), progression (HR = 5.5), and recurrence (HR = 6.3). Stage III disease was an independent risk factor for recurrence (HR = 9.5).
Conclusions
High NOS expression in RCC is associated with a poor prognosis and larger tumors. NOS3 influences OS by univariate analysis.