Predictive and prognostic value of aurora kinase A combined with tumor-infiltrating lymphocytes in medullary thyroid carcinoma

Abstract

Purpose Aurora kinase A (AURKA) plays an essential role in tumorigenesis by regulating the cell cycle. However, the expression and prognostic value of the AURKA in medullary thyroid carcinoma (MTC) have not been thoroughly investigated. Methods Surgical specimens and clinical data of 137 patients diagnosed with MTC were collected. AURKA expression and tumor-infiltrating lymphocytes (TILs) infiltration were estimated by immunohistochemistry and hematoxylin-eosin staining. Moreover, the prognostic value of AURKA expression and TIL infiltration in MTC was evaluated. Results AURKA was highly expressed in patients with multifocal tumor, lymph node metastasis, and advanced TNM stage, indicating a high probability of recurrence. AURKA exhibited a positive correlation with TILs (R = 0.44, P < 0.001). High expression of AURKA combined with low numbers of TILs (AURKAhigh/TILslow) was identified as an independent prognostic factor for biochemistry recurrence-free survival (hazard ratio: 4.57, 95% confidence interval: 1.54–14.66, P < 0.01) and structural recurrence-free survival (hazard ratio: 3.64, 95% confidence interval: 1.52–8.71, P < 0.001). The combination of AURKA and TILs apparently improves the prognostic value for biochemistry recurrence (area under the curve: 0.751) and structural recurrence (area under the curve: 0.836) of MTC. Particularly, AURKAhigh/TILslow demonstrated higher predictive ability for distant or unresectable locoregional recurrence, with an overall accuracy of 86.9%. Conclusion AURKAhigh is associated with the malignancy of MTC. The combination of AURKAhigh/TILslow was recognized as a novel independent prognostic marker in MTC, predicting incurable disease recurrence with high accuracy.