Background
Combination platinum chemotherapy is standard first line therapy for metastatic urothelial carcinoma (mUC) patients. Defining platinum response biomarkers for mUC patients, could establish personalize medicine and provide insights into mUC biology. While DNA repair mechanisms are hypothesized to mediate platinum response, we sought to analyze if increased expression of DNA damage genes correlates with a worse overall survival (OS) in mUC patients.
Methods
We retrospectively identified a clinically annotated cohort of mUC patients, treated with first-line platinum combination chemotherapy. A tissue microarray (TMA) was constructed from formalin fixed paraffin embedded (FFPE) tissue from the pre-treatment primary tumor. Immunohistochemical (IHC) analysis of the following DNA repair proteins; ERCC1, RAD51, BRCA1/2, PAR, and PARP-1, was performed. Nuclear and cytoplasmic expression was analyzed using multispectral image. Nuclear staining was used for the survival analysis. Cox regression evaluated the associations of the percentage of positive nuclear staining and OS in multivariable analysis, controlling for known prognostic variables.
Results
In a cohort of 104 mUC patients, higher nuclear staining percentage of ERCC1 [HR=2.7 (1.5, 4.9), p=0.0007], RAD51 [HR=5.6 (1.7, 18.3), p=0.005], and PAR [with HR=2.2 (1.1, 4.4) p=0.026] were associated with worse OS. BRCA1, BRCA2, and PARP-1 were not associated with OS (p=0.76, p=0.38, p=0.09). Higher combined ERCC1 and RAD51 nuclear staining were strongly associated with worse OS (p=0.005).
Conclusions
High nuclear staining percentage of ERCC1, RAD51, and PAR, as assessed by IHC, are correlated with worse OS for mUC patients treated with first line platinum combination chemotherapy, supporting the evidence of DNA repair pathways’ role in the prognosis of mUC. We have also produced new evidence that RAD51 and PAR may play a role in platinum response. Further prospective studies are required to determine the prognostic or predictive nature of these biomarkers in mUC.