Prognostic impact of TTF-1 expression in patients with stage IV lung adenocarcinomas

- TTF-1 positivity is associated with improved survival in lung adenocarcinomas.
- The prognostic impact of TTF-1 exceeds nearly all other clinicopathologic features.
- TTF-1 is not predictive of distinct benefit from pemetrexed chemotherapy.
- We advocate that TTF-1 should be routinely tested and reported in clinical trials.

ObjectivesThyroid transcription factor 1 (TTF-1) is routinely tested in the diagnostic evaluation of suspected lung cancers, is commonly expressed by lung adenocarcinomas, and may modulate lung cancer biology. We examined the role of TTF-1 as a predictive and prognostic marker in patients with advanced lung adenocarcinomas.Materials and methodsWe analyzed clinical, pathologic, and molecular features, treatments received, and overall survival obtained from the medical records of 479 consecutive patients at a single site with stage IV lung adenocarcinomas and evaluable TTF-1 expression. TTF-1 expression was determined by immunohistochemistry using antibody 8G7G3/1.Results and conclusionTTF-1 expression was evaluable in 479 (75%) of all patients reviewed, and was positive in 383 (80%, 95% CI 76-83%). Clinicopathologic features were similar between TTF-1 positive and TTF-1 negative tumors, except EGFR mutations were more common in TTF-1 positive cases (24% vs 6%, p < 0.001). In univariate analysis, overall survival was significantly longer in patients with TTF-1 positive versus TTF-1 negative tumors (18 months vs 9 months, p < 0.0001). In multivariate analysis, TTF-1 positivity remained associated with better overall survival (HR = 0.38, p < 0.0001), exceeding the prognostic impact of Karnofsky performance status >/= 80% (HR 0.62, p = 0.0003) and receipt of first-line combination chemotherapy or targeted therapy (HR relative to first-line single agent chemotherapy 0.59, p = 0.05 and 0.51, p = 0.05 respectively). Both patients with TTF-1 positive and TTF-1 negative cancers had longer durations of initial therapy when treated with pemetrexed-based chemotherapy. In patients with advanced lung adenocarcinomas, TTF-1 expression is associated with better survival but is not predictive of distinct benefit from pemetrexed-based chemotherapy.