Nuclear ELAC2 overexpression is associated with increased hazard for relapse after radical prostatectomy
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Cornelia Schroeder1,2,*, Elham Navid-Hill1,*, Jan Meiners2, Claudia Hube-Magg1, Martina Kluth1, Georgia Makrypidi-Fraune1, Ronald Simon1, Franziska Büscheck1, Andreas M. Luebke1, Cosima Goebel1, Dagmar S. Lang1, Sören Weidemann1, Emily Neubauer1, Andrea Hinsch1, Frank Jacobsen1, Patrick Lebok1, Uwe Michl3, Dirk Pehrke3,4, Hartwig Huland3, Markus Graefen3, Thorsten Schlomm3,4, Guido Sauter1 and Doris Höflmayer1
1 Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2 General, Visceral and Thoracic Surgery Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
3 Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
4 Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
* These authors contributed equally to this work
Keywords: ELAC2; HPC2; prostate cancer; prognosis; tissue microarray
Received: November 17, 2018 Accepted: July 21, 2019 Published: August 13, 2019
ELAC2 is a ubiquitously expressed enzyme potentially involved in tRNA processing and cell signaling pathways. Mutations of the ELAC2 gene have been found to confer increased prostate cancer susceptibility in families. ELAC2 protein expression was analyzed by immunohistochemistry in 9,262 patients and Kaplan-Meier curves of PSA recurrence-free survival were calculated in 8,513 patients treated with radical prostatectomy. Nuclear ELAC2 staining was observed in 60.8% of prostate cancers. It was weak in 26.3%, moderate in 26.6% and strong in 7.9%. Strong nuclear ELAC2 expression was associated with advanced tumor stage, nodal metastasis, higher Gleason grade, presence of TMPRSS2:ERG fusion, higher Ki67-labeling index and PTEN deletion. The difference in 1-, 5- and 10-year recurrence-free survival between strong and weak nuclear ELAC2 intensity is 7.2/13.8/17.6% in all cancers, 7.4/16.1/26.5% in the ERG negative subset, and 3.1/5.7/9.8% in the ERG positive subset. Regarding the univariate hazard ratio, PSA recurrence-free survival after prostatectomy for strong nuclear ELAC2 expression is 1.89 (1.64–2.10, p < 0.0001). It is independent of preoperative PSA-level, Gleason grade, pathological stage, surgical margin stage, and lymph node stage (multivariate hazard ratio 1.29 (1.11–1.49, p = 0.001). We conclude that nuclear ELAC2 expression is an independent prognostic marker for PSA recurrence-free survival after radical prostatectomy with a weak to moderate increase of the hazard ratio for biochemical relapse.
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