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Prognostic Value Of Her-2/Neu And DNA Index For Progression, Metastasis And Prostate Cancer-Specific Death After Radical Prostatectomy

October 04, 2017

UroToday - In the online version of the International Journal of Cancer, Dr. Sumit Isharwal and associates from Johns Hopkins University reported on the prognostic association between the Her-2/neu oncoprotein expression, abnormal DNA content and prostate cancer (CaP) progression. The investigators found a positive correlation.

The initial study cohort consisted of 252 men with clinically localized CaP treated with radical prostatectomy between 1980 and 1994. Patients were stratified into having Gleason score 7. For DNA content analysis, a minimum of 125 intact nuclei were captured from the cancer area for each patient. DNA content measurements were calculated and a % DNA index value generated. Her-2/neu expression in tissue sections was assessed by immunohistochemistry staining and counting. Patients were Her-2/neu negative, focally positive, and diffusely positive, if staining was present, in 30%, respectively.

A total of 147 patients had disease progression, 43.8% with distant metastasis while 26.3% died due to CaP. Mean follow-up after surgery was 15.3 years. The likelihood of disease progression after 10 and 15 years was 11% and 3.5%, respectively. The proportion of Her-2/neu positive tumors significantly increased from non-progressors (53%), to progressors without metastasis (70%), to progressors with metastasis (87%). The proportions of high %DNA index tumors increased from non-progressors (41%), to progressors without metastasis (69%), to progressors with metastasis (80%). Also, the proportions of Her-2/neu positive tumors significantly increased from patients who died from another cause without progression (62%) to men who died from another cause with progression (72%) to those who died due to CaP (86%). This was also the case for %DNA index, with the proportions of high %DNA index tumors significantly increased from patients who died from another cause without progression (38%) to men who died from another cause with progression (64%) to those who died due to CaP (83%).

Clinical and pathological variables, significant in univariate analysis, were included in multivariate analysis. For metastasis-free survival, Gleason score, %DNA index and Her-2/neu expression were significant. Gleason score, %DNA index, lymph node involvement, and Her-2/neu were significant for time to CaP-specific death in multivariable analysis. A bootstrap resampling procedure in 200 replications supported these findings. These data suggest that Her-2/neu expression and %DNA are clinicopathologic parameters for prediction of long-term prognosis in CaP.

Isharwal S, Miller MC, Epstein JI, Mangold LA, Humphreys E, Partin AW, Veltri RW. Are you the author?

Int J Cancer. 2008 Sep 2. Epub ahead of print.
doi:10.1002/ijc.23838

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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