ERG overexpression plus SLC45A3 (prostein) and PTEN expression loss: Strong association of the triple hit phenotype with an aggressive pathway of prostate cancer progression
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Silvia Hernández-Llodrà1,*, Nuria Juanpere1,2,*, Silvia de Muga1, Marta Lorenzo2, Joan Gil1, Alba Font-Tello3, Laia Agell1, Raquel Albero-González2, Laura Segalés1, José Merino4, Laia Serrano2, Lluís Fumadó5, Lluís Cecchini5 and Josep Lloreta Trull1,2
1Department of Health and Experimental Sciences, Universitat Pompeu Fabra, Barcelona, Spain
2Department of Pathology, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
3Dana Farber Cancer Institute, Boston, MA, USA
4Fundación Jiménez Díaz, Madrid, Spain
5Department of Urology, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
*These authors have contributed equally to this work
Silvia Hernández-Llodrà, email: [email protected]
Josep Lloreta Trull, email: [email protected]
Keywords: ERG, SLC45A3, PTEN, prostate cancer, progression
Received: August 10, 2016 Accepted: May 15, 2017 Published: May 26, 2017
TMPRSS2 and SLC45A3 rearrangements may coexist in the same tumor. ERG rearrangements and PTEN loss are concomitant events in prostate cancer (PrCa), and can cooperate in progression. We have reported that mRNA expression of TMPRSS2-ERG and SLC45A3-ERG rearrangements plus PTEN loss define an aggressive tumor subset. The aim of this study has been to validate these results by immunohistochemistry in a large cohort of tumors. ERG, SLC45A3 and PTEN immunostaining and their association with pathological features and PSA progression-free survival were analyzed in 220 PrCa (PSMAR-Biobank, Barcelona, Spain). ERG protein expression was found in 46.8% and SLC45A3 and PTEN loss in 30% and 34% tumors, respectively. Single ERG positive immunostaining was associated with GS = 6 tumors (p = 0.016), double ERG+/PTEN loss with GS = 7 (p = 0.008) and Grade Group 2 (GG) or GG3 cases (p = 0.042), ERG+/SLC45A3 loss/PTEN loss (“triple hit”) with GS ≥ 8 (p < 0.0001) and GG4 or GG5 tumors (p = 0.0003). None of GS = 6 nor = GG1 cases showed this combination. In the GS ≥ 8 group, ERG+ (p = 0.002), PTEN loss (p = 0.009) and “triple hit” (p = 0.003) were associated with Gleason pattern 3 component, and single SLC45A3 loss (p = 0.036) with GS ≥ 8 without pattern 3. The number of aberrant events and the triple hit were strongly associated with shorter PSA progression-free survival. In GS = 6 PrCa, single ERG+ was also associated with progression. ERG+ identifies a distinct pathway of PrCa. Additional assessment of PTEN and SLC45A3 adds relevant prognostic information. The triple hit phenotype (ERG+/SLC45A3 loss/PTEN loss) is associated with progression and could be used for patient stratification, treatment and follow-up.
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