1. Mutations in TP53 or DNA damage repair genes define poor prognostic subgroups in primary prostate cancer
- Author
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Lars Pursche, Elena Walter, Fabian Falkenbach, Ruth Himmelsbach, Martina Heller, Cathleen Nientiedt, Viktoria Schütz, Desiree Franke, Gita Schönberg, Christine Geisler, Jan Budczies, Svenja Dieffenbacher, Stefan Duensing, Philippa Lantwin, Iva Simunovic, Stefanie Zschäbitz, Stefan A. Koerber, Carine Pecqueux, Martina Kirchner, Christina Jurcic, Claudia Gasch, Jürgen Debus, Shirin Hoveida, Volker Endris, Gencay Hatiboglu, Rouven Behnisch, Markus Hohenfellner, Anette Duensing, Dirk Jäger, Joanne Nyarangi-Dix, Constantin Schwab, Peter Schirmacher, Holger Sültmann, Adam Kaczorowski, Magdalena Görtz, Mathias Rath, Albrecht Stenzinger, Philipp Reimold, and Luisa Hofer
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,DNA Repair ,Urology ,medicine.medical_treatment ,Gene mutation ,medicine.disease_cause ,Proof of Concept Study ,DNA sequencing ,Prostate cancer ,PSA Failure ,Prostate ,Internal medicine ,medicine ,Humans ,Gene ,Aged ,Mutation ,business.industry ,Prostatectomy ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,Prognosis ,medicine.anatomical_structure ,Tumor Suppressor Protein p53 ,business - Abstract
Background Mutations in DNA damage repair genes, in particular genes involved in homology-directed repair, define a subgroup of men with prostate cancer with a more unfavorable prognosis but a therapeutic vulnerability to PARP inhibition. In current practice, mutational testing of prostate cancer patients is commonly done late i.e., when the tumor is castration resistant. In addition, most sequencing panels do not include TP53, one of the most crucial tumor suppressor genes in human cancer. In this proof-of-concept study, we sought to extend the clinical use of these molecular markers by exploring the early prognostic impact of mutations in TP53 and DNA damage repair genes in men with primary, nonmetastatic prostate cancer undergoing radical prostatectomy (RPX). Methods Tumor specimens from a cohort of 68 RPX patients with intermediate (n = 11, 16.2%) or high-risk (n = 57, 83.8%) disease were analyzed by targeted next generation sequencing using a 37 DNA damage repair and checkpoint gene panel including TP53. Sequencing results were correlated to clinicopathologic variables as well as PSA persistence or time to PSA failure. In addition, the distribution of TP53 and DNA damage repair gene mutations was analyzed in three large publicly available datasets (TCGA, MSKCC and SU2C). Results Of 68 primary prostate cancers analyzed, 23 (33.8%) were found to harbor a mutation in either TP53 (n = 12, 17.6%) or a DNA damage repair gene (n = 11, 16.2%). The vast majority of these mutations (22 of 23, 95.7%) were detected in primary tumors from patients with high-risk features. These mutations were mutually exclusive in our cohort and additional data mining suggests an enrichment of DNA damage repair gene mutations in TP53 wild-type tumors. Mutations in either TP53 or a DNA damage repair gene were associated with a significantly worse prognosis after RPX. Importantly, the presence of TP53/DNA damage repair gene mutations was an independent risk factor for PSA failure or PSA persistence in multivariate Cox regression models. Conclusion TP53 or DNA damage repair gene mutations are frequently detected in primary prostate cancer with high-risk features and define a subgroup of patients with an increased risk for PSA failure or persistence after RPX. The significant adverse impact of these alterations on patient prognosis may be exploited to identify men with prostate cancer who may benefit from a more intensified treatment.
- Published
- 2021