Department of Urology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Chin Med J (Engl). 2013 Jan;126(1):82-7.
c-Myc, EZH2 and p27 were defined to modulate the behavior of prostate cancer with pro-tumoral or anti-tumoral effects and had ability in predicting prostate cancer progression, but the research of their co-expression value of prognosis is rarely. This study aimed to investigate the prognostic value of combining tri-marker together in patients with intermediate-risk prostate cancer after surgery.
Expression levels of c-Myc, EZH2 and p27 in 129 patients with intermediate-risk prostate cancer were assessed using immunohistochemistry in a semi-quantitative manner. The expression profiles of these three markers were analyzed and investigated for association with biochemical recurrence.
In all, fifty of 129 cases experienced biochemical recurrence during a median follow-up time of 31 months (range, 6 - 60 months). Of these relapse patients, one case without and 10 cases with any single positive marker were observed; 39 cases were detected with any two or all three positive markers (22 cases with any two and 17 cases with all three positive markers). Survival analysis showed that patients with over-expression of c-Myc or EZH2, and lower expression of p27 manifested significantly higher biochemical recurrence rates. Subsequent multivariate analysis revealed that c-Myc, EZH2 and p27 expression statuses showed potential in predicting relapse, respectively. Notably, combining three markers together as a "composite index" (0 or 1, vs. 2 or 3 positive markers) provided powerful prognostic value (HR 6.57, 95% CI 3.02 - 14.31, P < 0.001). There was a significant difference between the patient subgroups with 0 or 1 and those with 2 or 3 positive markers expression statuses, and tri-marker composite index was an independent risk factor for predicting relapse in patients with intermediate-risk prostate cancer after surgery.
Composite index of c-Myc, EZH2, and p27 can be valued as powerful prognosis parameter for intermediate-risk prostate cancer patients after the surgery, and postoperative adjuvant therapy can be adopted accordingly.
c-Myc、EZH2 和 p27 被定义为具有促肿瘤或抗肿瘤作用，能够预测前列腺癌进展，但关于它们共同表达对预后的价值的研究很少。本研究旨在探讨联合三种标志物检测对术后中危前列腺癌患者的预后价值。
采用免疫组织化学半定量法检测 129 例中危前列腺癌患者 c-Myc、EZH2 和 p27 的表达水平。分析三种标志物的表达谱，并探讨其与生化复发的关系。
在中位随访时间为 31 个月（范围 6-60 个月）期间，共有 129 例患者发生生化复发。其中，1 例无单阳性标志物，10 例有单阳性标志物；39 例检测到任何两种或三种阳性标志物（22 例有两种阳性标志物，17 例有三种阳性标志物）。生存分析显示，c-Myc 或 EZH2 过表达、p27 低表达的患者生化复发率明显较高。进一步的多因素分析显示，c-Myc、EZH2 和 p27 的表达状态分别具有预测复发的潜力。值得注意的是，将三种标志物联合作为“复合指数”（0 或 1 个 vs. 2 或 3 个阳性标志物）具有强大的预后价值（HR 6.57，95%CI 3.02-14.31，P<0.001）。0 或 1 个和 2 或 3 个阳性标志物表达状态的患者亚组之间存在显著差异，复合指数是术后中危前列腺癌患者预测复发的独立危险因素。
c-Myc、EZH2 和 p27 的复合指数可作为中危前列腺癌患者术后的有力预后指标，并可据此进行术后辅助治疗。
