Mismatch repair deficiency and aberrations in the Notch and Hedgehog pathways are of prognostic value in patients with endometrial cancer

PLoS One. 2018 Dec 6;13(12):e0208221. doi: 10.1371/journal.pone.0208221. eCollection 2018.

Abstract

The aim of this study was to investigate the prognostic value of the Hedgehog (Gli, Patched-1, Shh, Smo) and Notch (Jag1, Notch2, Notch3) pathway members, in comparison to a panel of proteins (ER, PgR, HER2/neu, Ki67, p53, p16, PTEN and MMR) previously suggested to be involved in the pathogenesis of endometrial cancer, in association with clinical outcome and standard clinicopathological characteristics. A total of 204 patients with histological diagnosis of endometrial cancer treated from 2004 to 2013 were included. The evaluation of protein expression was assessed by immunohistochemistry. Univariate analysis showed that higher Ki67 labeling, expression of PTEN, p16, Notch2 and Notch3 proteins, as well as MMR proficiency were associated with increased relapse and mortality rate. Additionally, Patched-1 protein expression was associated with worse DFS, while p53 overexpression was associated with worse OS. In multivariate analyses, patients with MMR proficient tumors had more than double risk for death than patients with MMR deficient (MMRd) tumors (adjusted HR = 2.19, 95% CI 1.05-4.58, p = 0.036). Jag1 positivity conferred reduced mortality risk (HR = 0.48, 95% CI 0.23-0.97, p = 0.042). However, as shown by hierarchical clustering, patients fared better when their tumors expressed high Jag1 protein in the absence of Notch2 and Notch3, while they fared worse when all three proteins were highly expressed. Patched-1 positivity conferred higher risk for relapse (HR = 2.04, 95% CI 1.05-3.96, p = 0.036). Aberrant expression of key components of the Notch and Hedgehog signaling pathways, as well as MMRd may serve as independent prognostic factors for recurrence and survival in patients with endometrial cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / genetics
  • Biomarkers, Tumor / metabolism
  • Cluster Analysis*
  • DNA Mismatch Repair / genetics
  • DNA Mismatch Repair / physiology
  • Endometrial Neoplasms / genetics
  • Endometrial Neoplasms / metabolism*
  • Endometrial Neoplasms / pathology*
  • Female
  • Hedgehog Proteins / genetics
  • Hedgehog Proteins / metabolism*
  • Humans
  • Jagged-1 Protein / genetics
  • Jagged-1 Protein / metabolism
  • Middle Aged
  • Patched-1 Receptor / genetics
  • Patched-1 Receptor / metabolism
  • Prognosis
  • Receptor, Notch2 / genetics
  • Receptor, Notch2 / metabolism
  • Receptor, Notch3 / genetics
  • Receptor, Notch3 / metabolism
  • Receptors, Notch / genetics
  • Receptors, Notch / metabolism*
  • Signal Transduction / genetics
  • Signal Transduction / physiology

Substances

  • Biomarkers, Tumor
  • Hedgehog Proteins
  • JAG1 protein, human
  • Jagged-1 Protein
  • NOTCH2 protein, human
  • NOTCH3 protein, human
  • Patched-1 Receptor
  • Receptor, Notch2
  • Receptor, Notch3
  • Receptors, Notch

Grants and funding

This study was supported by an internal Hellenic Cooperative Oncology Group (HeCOG) translational research grant (HE TRANS_E) and by a Hellenic Society for Medical Oncology (HeSMO) grant. The funders played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.