Background: Increased expression of DEF6 is correlated with the malignant behavior of various cancers. Both DEF6 and\np16 contribute to the regulation of cell cycle progression, and p53 plays important role in the cell cycle checkpoints. This\nstudy was designed to elucidate the prognostic significance of DEF6, p53 and p16 immunoexpressions in different\nhistology subtypes of ovarian carcinoma.\nMethods: Immunohistochemistry results of DEF6, p53 and p16 on ovarian carcinoma were compared with histology\nsubtypes, clinical data, overall survival (OS) and disease-free survival (DFS) by Cox regression and Kaplan-Meier analysis.\nResults: We studied 180 cases of ovarian carcinomas (75 high-grade serous, 41 clear cell, 36 mucinous and 28\nendometrioid), including 109 FIGO stage I-II cases and 71 FIGO stage III-IV cases. Ovarian carcinomas positive for both\nDEF6 and p16 expression were associated with the worst OS (P = 0.027) and DFS (P = 0.023), whereas those negative for\nboth DEF6 and p16 had the best OS and DFS. Aberrant p53 expression combined with positive DEF6 was associated with\nworst OS (P = 0.031) and DFS (P = 0.028). Kaplan-Meier analysis showed that significantly shorter survival rates were seen\nin patients with high expressions of DEF6 (P = 0.008) and p16 (P = 0.022). Patients with aberrant p53 expression in highgrade\nserous carcinoma (P = 0.012) and patients with high DEF6 expression in clear cell carcinoma (P = 0.001) were also\nassociated with shorter overall survival. In univariate analysis, FIGO stage, DEF6 and p16 were associated with poor\nprognosis. DEF6 expression was the only independent prognostic factor correlated with shorted OS (HR 2.115; P= 0.025)\nand DFS (HR 2.248; P = 0.016) upon multivariate analysis.\nConclusions: DEF6 expression may serve as an independent prognostic factor, and interacted positively with p16 toward\nhigh tumor stage and shorter survival.
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