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CCND1/CyclinD1 status in metastasizing bladder cancer: a prognosticator and predictor of chemotherapeutic response.

转移性膀胱癌中的CCND1/CyclinD1状态:一个预后及化疗反应的预测因子。

Seiler R,Thalmann GN,Rotzer D,Perren A,Fleischmann A

Abstract

The CCND1 gene encodes the protein CyclinD1, which is an important promoter of the cell cycle and a prognostic and predictive factor in different cancers. CCND1 is amplified to a substantial proportion in various tumors, and this may contribute to CyclinD1 overexpression. In bladder cancer, information about the clinical relevance of CCND1/CyclinD1 alterations is limited. In the present study, amplification status of CCND1 and expression of CyclinD1 were evaluated by fluorescence in situ hybridization and immunohistochemistry on tissue microarrays from 152 lymph node-positive urothelial bladder cancers (one sample each from the center and invasion front of the primary tumors, two samples per corresponding lymph node metastasis) treated by cystectomy and lymphadenectomy. CCND1 amplification status and the percentage of immunostained cancer cells were correlated with histopathological tumor characteristics, cancer-specific survival and response to adjuvant chemotherapy. CCND1 amplification in primary tumors was homogeneous in 15% and heterogeneous in 6% (metastases: 22 and 2%). Median nuclear CyclinD1 expression in amplified samples was similar in all tumor compartments (60-70% immunostained tumor nuclei) and significantly higher than in non-amplified samples (5-20% immunostained tumor nuclei; P<0.05). CCND1 status and CyclinD1 expression were not associated with primary tumor stage or lymph node tumor burden. CCND1 amplification in primary tumors (P=0.001) and metastases (P=0.02) and high nuclear CyclinD1 in metastases (P=0.01) predicted early cancer-related death independently. Subgroup analyses showed that chemotherapy was particularly beneficial in patients with high nuclear CyclinD1 expression in the metastases, whereas expression in primary tumors and CCND1 status did not predict chemotherapeutic response. In conclusion, CCND1 amplification status and CyclinD1 expression are independent risk factors in metastasizing bladder cancer. High nuclear CyclinD1 expression in lymph node metastases predicts favorable response to chemotherapy. This information may help to personalize prognostication and administration of adjuvant chemotherapy.

摘要

 CCND1基因编码 CyclinD1蛋白,这是一种细胞周期的重要启动子和多种癌症的预后和预测因子。CCND1在多种肿瘤中扩增到相当大的比例,而这可能促进 CyclinD1的过表达。在膀胱癌中,有关CCND1/CyclinD1变化与临床相关性的认识有限。本研究收集152例接受过膀胱切除术和淋巴结清扫术的有淋巴结转移的膀胱尿路上皮癌(每一个采自原发肿瘤中心及侵袭前沿的样本,都有两个相应的淋巴结转移的标本)标本制作成组织芯片,并采用FISH及免疫组化检测 CCND1 的扩增状态及 CyclinD1的表达状态。 CCND1的扩增状态、免疫染色阳性的癌细胞的百分比与肿瘤的组织病理学特征、肿瘤特异性生存率及对辅助化疗的反应性有关。 CCND1在原发肿瘤中的扩增有15%是均质性的,6%是异质性的 (转移分别为22%、2%)。在扩增样本中核 CyclinD1表达的中位值与在所有肿瘤成分中的一致(60-70%的肿瘤细胞核免疫染色阳性),显著高于非扩增样本( (5-20% 肿瘤细胞核免疫染色阳性; P<0.05)。 CCND1的状态和 CyclinD1的表达与原发肿瘤的分期及淋巴结肿瘤负荷无关。原发肿瘤(P=0.001)和转移肿瘤(P=0.03)中的CCND1扩增、以及转移瘤中cyclinD1核高表达  (P=0.01)能分别预测早期癌症相关的死亡。亚组分析显示,在转移灶中有高核CyclinD1表达的病例对化疗敏感,而在原发肿瘤中的表达及CCND1的状态则不能预测化疗反应。总之, CCND1的扩增状态和 CyclinD1的表达是转移性膀胱癌的独立危险因素。在淋巴结转移中的高核 CyclinD1表达预示对化疗相对敏感。这些信息可能有助于对辅助化疗的个体化预测和管理。

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