The influence of iPS-inducing factors NANOG and KLF4 in the prognosis of patients with breast cancer.
230 Background: iPS cell-inducing factors (Oct3/4, Sox2, Klf4, c-Myc, and Nanog) are reported that they appears not only in ES cells (embryonic stem cell), but also in normal cell or carcinoma cell, including breast carcinoma. We evaluated the expression of iPS inducing factors in the human breast cancer specimen with immunohistochemistry, and analyze the relativity of the relapse and the prognosis after the operation. Methods: 66 cases of breast cancer that were performed the surgical operation in this department were examined. Expression of c-MYC, KLF4, NANOG, OCT4, and SOX2 were determined by immunohistochemistry of tissue microarray. Results: The average of the patient’s age was 56.4 years old (36-87), and the advanced breast cancers in stage 2 or more were 44 cases (66%). About the hormone receptor and the HER2 appearance, hormone receptor-positive (HR+) types were 53 cases (80%), 6 cases (9%) were HER2-positive (HER2+) type, and 7 cases (11%) were triple-negative (TN) type. During the following period from operation, the relapse was found in 16 cases (24%), and six cases (9%) died. The average of survival time after the operation was 80.7 months (4-162). Patients with high expression group of NANOG had poor disease-free survival (p = 0.045) and overall survival (p < 0.0001) than those with low expression group. On the other hand, patients with high expression group of KLF4 had better disease-free survival (p = 0.028) than low expression group. Conclusions: High expression of NANOG was prognostic factor, but KLF4 was inversely related to prognosis in breast cancer patients. It was suggested that NANOG increased the growth and metastatic activities of breast cancer cells, while KLF4 decreased these activities.