Networking with fibrinogen: a prerequisite for fibroblast growth factor-2 (FGF-2)-stimulated tumor growth?

Combination of preoperative fibrinogen concentration and neutrophil-to-lymphocyte ratio for prediction of the prognosis of patients with resectable breast cancer

Previous studies have demonstrated that the combination of high preoperative fibrinogen levels and high neutrophil-to-lymphocyte ratio (NLR) is associated with poor outcomes in various types of cancer. The present study assessed the prognostic value of a scoring system based on the combination of fibrinogen concentration and neutrophil-to-lymphocyte ratio (F-NLR) in untreated patients with resectable breast cancer (BC). The present study retrospectively analyzed 906 patients who received surgery for resectable BC. Univariate and multivariate analyses were performed to explore the association between the F-NLR score and survival status. The cut-off values for fibrinogen and NLR determined via receiver operating characteristic curve analysis were 3.21 g/l and 2.20, respectively. On the basis of these cut-off values, the whole cohort was divided into three groups according to their F-NLR score: Score 2, fibrinogen ≥3.21 g/l and NLR ≥2.20; score 1, fibrinogen ≥3.21 g/l or NLR ≥2.20; and score 0, fibrinogen <3.21 g/l and NLR <2.20. The F-NLR score was significantly associated with age (≤50 years vs. >50 years; P<0.001), tumor size (≤2 cm vs. >2 cm; P=0.001), lymph node status (P=0.029), TNM stage (I vs. II vs. III; P=0.002) and lymphovascular invasion (P<0.001). The 5-year disease-free survival (DFS) rates in the patients with F-NLR scores of 0, 1 and 2 were 95.7, 87.5 and 74.0%, respectively (P<0.001), and the 5-year overall survival (OS) rates were 97.8, 90.9 and 79.9%, respectively (P<0.001). Furthermore, multivariate analysis demonstrated that the F-NLR score independently predicted DFS [hazard ratio (HR), 2.279; 95% CI, 1.758-2.954; P<0.001] and OS (HR, 2.414; 95% CI, 1.738-3.353; P<0.001). In conclusion, the preoperative F-NLR score was an independent prognostic indicator for untreated patients with resectable BC.

The VE-cadherin binding domain of fibrinogen induces endothelial barrier permeability and enhances transendothelial migration of malignant breast epithelial cells

Fibrin deposition and exudation of plasma fibrinogen (Fg) have long been recognized as hallmarks of inflammation, cardiovascular disease and neoplasia. The Fg-beta(15-42) domain binds to the endothelial cell adhesion molecule, VE-cadherin, promoting endothelial cell proliferation, angiogenesis and leukocyte diapedesis. Furthermore, spontaneous blood-borne and lymphatic metastasis of some types of tumor emboli requires plasma fibrin(ogen); however, the molecular mechanisms by which this occurs are poorly understood. We sought to determine whether Fg-beta(15-42) and VE-cadherin binding interactions promote endothelial barrier permeability and breast cancer cell transendothelial migration (TEM) using transwell insert culture systems. Synthetic peptides containing/missing residues beta(15-17) critical for Fg-beta(15-42) binding to VE-cadherin, and antibodies that bind to Fg-beta(15-21) (T2G1) and VE-cadherin (BV9) were used to induce or inhibit Fg-mediated permeability and TEM. Fg induced dose-dependent permeability of human umbilical vein and microvascular endothelial but not epithelial cell barriers. Maximal Fg-induced endothelial permeability required Fg-beta(15-42) and VE-cadherin-binding interactions involving Fg-beta(15-17). Fg-induced TEM of malignant MDA-MB-231 and MCF-7 breast cancer cells also required Fg-beta(15-42) and VE-cadherin binding; however, such TEM was independent of E-cadherin or estrogen receptor expression. In contrast, Fg did not induce TEM of nonmalignant MCF-10A breast epithelial cells. Fg-induced endothelial permeability was retained in the presence of MDA-MB-231 but inhibited in the presence of MCF-10A cells. It is intriguing to speculate that loss of Fg-beta(15-42) binding by premalignant breast epithelial cells serves as a molecular switch to induce a highly aggressive, metastatic breast cancer phenotype. Hence, Fg-beta(15-42) represents a potential molecular target for therapeutic intervention of breast cancer metastasis.