Background. In the search for tumor-related antigens with survival-pre
dictive value, previous studies have yielded varied conclusions regard
ing the expression of one such antigen, the transferrin receptor in lu
ng cancer. The goal of this study was to define the frequency of expre
ssion of transferrin receptor in lung cancer specimens and gather prel
iminary data regarding the prognostic value of this tumor-related anti
gen. Methods. Tissue immunoreactivity was studied with a murine monocl
onal antibody to transferrin receptor in patients with nonsmall cell l
ung cancer who underwent surgical resection at the Medical Center Hosp
ital of Vermont during the period from January, 1988, to May, 1991. Re
sults. The study group consisted of 32 patients (21 males and 11 femal
es) with an average follow-up length of 27 months (standard deviation
of 16 months). There were 17 patients with adenocarcinoma, 14 with squ
amous cell carcinoma, and 1 with large cell carcinoma. At the end of d
ata accumulation, a total of 16 deaths had been recorded (8 with squam
ous cell, 8 with adenocarcinoma). Normal lung tissue did not stain for
transferrin receptor; however, 13 of 17 (76%) adenocarcinomas, 13 of
14 (93%) squamous cell carcinomas, and the 1 large cell carcinoma stai
ned positively for transferrin receptor. Staining for transferrin rece
ptor was graded according to pattern and intensity and categorized as
absent-weak or strong. Survival analysis was performed to evaluate pat
ient outcome based on a variety of clinical and experimentally determi
ned characteristics. Groups based on N-status (NO vs. N1 + N2, P = 0.0
8), stage (Stage 1 vs. Stage 2 + 3, P = 0.13), age (younger than 60 vs
. 60 years or older, P = 0.09), and transferrin receptor staining (abs
ent-weak vs. strong, P = 0.14) achieved nearly significant differences
in survival. Further analysis of the differences in survival for grou
pings based on transferrin receptor staining found that these differen
ces in survival reached significance for patients with larger tumors (
T2 or T3, P = 0.02). Conclusions. Transferrin receptor is expressed in
the majority of lung cancers and the presence of transferrin receptor
in nonsmall cell lung cancers may be an indicator of poorer prognosis
in certain groups of patients.