Serpin b3 is associated with poor survival after chemotherapy and is a potential novel predictive biomarker in advanced non-small-cell lung cancer

Gordon Urquhart, Keith M Kerr, Marianne Nicolson, Peh Sun Loo, Ravi Sharma, Raj Shrimali, Russell D. Petty

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


INTRODUCTION: In a previous biomarker discovery project using gene-expression profiling we identified Serpin B3 (SB3) as a predictor of resistance to platinum doublet chemotherapy (PtC) in non-small-cell lung cancer (NSCLC). This independent prospective study was designed to confirm the predictive utility of SB3.

METHODS: SB3 immunohistochemistry was scored by previously validated criteria (score 0 = negative, score 1 = 1%-10% tumor cells positive, score 2 = 11%-50% tumor cells positive, and score 3 = >50% tumor cell positive) in 197 patients with stage IV NSCLC treated with PtC. This provided 80% power to detect a median survival increase from 150 days in patients with an SB3 immunohistochemistry score of 2 or more to 300 days in those with an SB3 score of 0 or 1.

RESULTS: Thirty-six percent of NSCLCs stained positive for SB3. Median survival for SB3 negative/score 0 was 332 days, SB3 positive/score 1 was 268 days, and SB3 positive/score 2 or 3 was 120 days (p = 0.004). Cox proportional hazards analysis demonstrated that SB3 positivity is an independent predictor of survival (hazard ratio = 1.87; 95% confidence interval, 1.29-2.71; p = 0.001).The disease control rate in SB3 score 0, 1 = 65%, and score of 2 or more = 20 % (p = 0.002), with median survival 306 days (score 0, 1) versus 120 days (score ≥ 2, hazard ratio= 1.71; 95% confidence interval. 1.14-3.10; p = 0.002).

CONCLUSIONS: SB3-positive immunohistochemistry score of 2 or more (>10% tumor cells positive) identifies a subgroup of patients with stage IV NSCLC who have a poor survival (median 120 days) when treated with PtC, similar to that estimated for untreated or chemo-refractory stage IV NSCLC. Further prospective qualification using biospecimens from randomized studies is needed, but SB3 seems to be a useful biomarker that identifies a highly resistant subgroup in whom PtC should be avoided.

Original languageEnglish
Pages (from-to)1502-1509
Number of pages8
JournalJournal of Thoracic Oncology
Issue number12
Publication statusPublished - Dec 2013


  • adenocarcinoma
  • adult
  • aged
  • antigens
  • neoplasm
  • antineoplastic combined chemotherapy protocols
  • carcinoma
  • large cell
  • non-small-cell lung
  • squamous cell
  • female
  • follow-up studies
  • humans
  • immunoenzyme techniques
  • lung neoplasms
  • male
  • middle aged
  • neoplasm Staging
  • prognosis
  • prospective studies
  • serpins
  • survival rate
  • tumor markers
  • biological


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