Enhancer of zeste homologue 2 (EZH2) expression in synovial sarcomas as a promising indicator of prognosis

Abstract

Synovial sarcoma (SS) is a type of soft-tissue sarcoma, often linked to poor survival. Although overexpression of enhancer of zeste homologue 2 (EZH2) has been associated with poor prognosis in different tumors, a few studies investigated this link in SS. Here, we analyzed the relationship between EZH2 expression and prognostic factors in SS. We included 29 patients with SS. Immunostaining of EZH2 was performed with (D2C9) XPTM Rabbit mAb antibody, and the results were classified as low EZH2 expression (negative or weak expression) and high EZH2 expression category (moderate or strong expression). Analysis of survival in relation to prognostic factors was performed with Kaplan-Meier survival curves and Cox proportional hazard regression analysis. Our sample included 19/29 female and 10/29 male patients, with age range 16-63 years. The tumor diameter ranged from 2 to 15 cm. Necrosis was observed in 15/29 cases. Sixteen cases had >10 mitoses per 50 high-power fields (HPFs). Out of 29 cases, 14 showed low and 15 had high EZH2 expression. Statistically significant results were obtained for the association between the presence of metastasis and necrosis (p = 0.042), high EZH2 expression and distant metastasis (p = 0.018), high EZH2 expression and necrosis (p = 0.016), and high EZH2 expression and the tumor size >5 cm versus tumor size ≤5 cm (p = 0.014). Patients with all of the following: the tumor size ≤5 cm, low EZH2 expression, and without necrosis and distant metastasis had significantly longer survival time. Our results are consistent with previous studies, suggesting that EZH2 overexpression is an indicator of poor prognosis in SS.

EZH2 is a potential prognostic predictor of glioma

“…Our results verify that EZH2 displays obviously higher expression in glioma tissues than in adjacent normal tissues. Furthermore, low EZH2 expression in glioma patients from the CGGA database was significantly related to better pathologic stage, histological grade and satisfactory survival time, which supports findings from other studies 29‐31 . Although the EZH2 expression level was correlated with other clinical parameters, our results demonstrate that EZH2 expression also may provide an independent predictor of overall survival in glioma patients.…”

“…Furthermore, low EZH2 expression in glioma patients from the CGGA database was significantly related to better pathologic stage, histological grade and satisfactory survival time, which supports findings from other studies. [29][30][31] Although the EZH2 expression level was correlated with other clinical parameters, our results demonstrate that EZH2 expression also may provide an independent predictor of overall survival in glioma patients. We constructed a risk score that could predict the prognosis of glioma patients by integrating the EZH2 expression with five clinicopathological variables including PRS type, Grade, Chemo status, IDH mutation and 1p19q status.…”

Prospects for Epigenetic Targeted Therapies of Bone and Soft-Tissue Sarcomas

“…reported that poorly differentiated synovial sarcoma had higher expression of EZH2 compared to monophasic and biphasic synovial sarcomas and that EZH2 levels were found to correlate with the expression of Ki-67 and, as expected, H3K27me3 [25]. Furthermore, Yalcinkaya et al validated these finding and showed that mutation or overexpression of EZH2 in soft-tissue sarcomas was associated with larger tumor size and worse clinical outcomes [26].…”

Forequarter amputation post transarterial chemoembolization and radiation in synovial sarcoma: A case report

“…Under 20 years of age, lower tumor stage, tumor size < 5 cm, sufficient excision, and a more distal position of the extremities are factors associated with better prognosis. Poor prognosis predictors include less-differentiated tumor regions, necrosis, and high mitotic activity [ 28 ]. Bleeding is a common concern in patients with advanced cancer and can occur in 6–10% of advanced cancer cases; a few of these cases may be the direct cause of death for at least one episode.…”