Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastric Cancer

Abstract

Background: Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) are represent for poor prognosis of various cancers. However, rare research investigate the correlation of them in cancer. This study aimed to investigate the correlation and prognostic value of P4HB and GRP78 expression along with clinical features in gastric cancer (GC).Methods: A total of 150 GC tissue samples separately evaluated P4HB and GRP78 protein expression by immunohistochemistry. Association of P4HB and GRP78 expression with clinicopathological features was analyzed. Bioinformatics analyses were performed to find correlation between mRNAs and pathways. Kaplan-Meier analyses were taken to compare survival curves. Univariate and multivariate Cox regression models used to analyze the impact of prognostic factors on overall survival (OS). A prognostic nomogram was constructed based on the multivariate Cox regression model, and compared to TNM stage in discrimination ability and clinical usefulness.Results: P4HB and GRP78 expression were both associated with tumor invasion and lymph node metastasis. P4HB protein positively correlated with GRP78, as well as the same tendency of mRNAs in both GC tissue and cell databases. Bioinformatics analyses indicated that P4HB and GRP78 may be associated with protein folding and response to ER stress, and the protein processing in ER pathway. High single or co-expression of P4HB and GRP78 represented for a shorter OS. When stratified by postoperative adjuvant chemotherapy, the high co-expression was only related to unfavorable prognosis of with chemotherapy group, especially in advanced stage. Multivariate Cox regression analysis identified co-expression of P4HB and GRP78 as an independent prognostic factor for OS. The nomogram including the co-expression was better than TNM stage in discrimination ability and clinical usefulness through the receiver operating characteristic (ROC) and decision curve analysis (DCA) curves.Conclusion: P4HB was positively correlated with GRP78 expression, co-expression of them was an independent prognostic factor, could serve as a predictive marker for GC patients with postoperative adjuvant chemotherapy in advanced stage.