title: Gene expression of topoisomerase II alpha (TOP2A) by microarray analysis is highly prognostic in estrogen receptor (ER) positive breast cancer.
abstract: BACKGROUND
  Overexpression of Topoisomerase II alpha (TOP2A) has been implicated with gene amplification of the 17q21 amplicon and consecutively with ErbB2 overexpression and amplification. However, gene amplification does not necessarily correlate with RNA and protein expression. There is growing evidence that TOP2A protein expression is a strong prognostic and TOP2A gene amplification might be a predictive marker (particularly for the use of anthracyclines).
  
  
  METHODS
  Large scale analysis was performed using Affymetrix microarray data from n = 1,681 breast cancer patients to evaluate TOP2A expression.
  
  
  RESULTS
  TOP2A expression showed a strong correlation with tumor size (chi(2)-test, P < 0.001), grading (P < 0.001), ErbB2 (P < 0.001) and Ki67 expression (P < 0.001) as well as nodal status (P = 0.042). Survival analysis revealed a significant prognostic value in ER positive (n = 994; log rank P < 0.001), but not in ER negative breast cancer patients (n = 369, P = 0.35). The prognostic impact of TOP2A expression was independent of Ki67 expression in ER positive tumors (P = 0.002 and P = 0.007 for high and low Ki67, respectively). Moreover a worse prognosis of high TOP2A expressing tumors was found in the subgroup of ErbB2 negative tumors (P < 0.001) and a trend among ErbB2 positive tumors (P = 0.11). The prognostic value of TOP2A was independent of whether the patients were untreated or had received adjuvant therapy. In multivariate Cox regression analysis including standard parameters TOP2A emerged to be the top prognostic marker (HR 2.40, 95% CI 1.68-3.43, P < 0.001).
  
  
  CONCLUSIONS
  TOP2A expression is an independent prognostic factor in ER positive breast cancer and could be helpful for risk assessment in ER positive breast cancer patients.
authors.affiliation: Department of Obstetrics and Gynecology, JW Goethe University, Frankfurt, Germany. achim.rody@em.uni-frankfurt.de
authors.forename: A
authors.initials: A
authors.lastname: Rody
authors.forename: T
authors.initials: T
authors.lastname: Karn
authors.forename: E
authors.initials: E
authors.lastname: Ruckhäberle
authors.forename: V
authors.initials: V
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Gehrmann
authors.forename: C
authors.initials: C
authors.lastname: Solbach
authors.forename: A
authors.initials: A
authors.lastname: Ahr
authors.forename: R
authors.initials: R
authors.lastname: Gätje
authors.forename: U
authors.initials: U
authors.lastname: Holtrich
authors.forename: M
authors.initials: M
authors.lastname: Kaufmann
mesh_terms: D000951:Antigens, Neoplasm / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics* / Q000378:metabolism; D004250:DNA Topoisomerases, Type II / Q000235:genetics*; D004268:DNA-Binding Proteins / Q000235:genetics*; D005260:Female; D005784:Gene Amplification; D015870:Gene Expression; D006801:Humans; D046228:Microarray Analysis; D008875:Middle Aged; D000075223:Poly-ADP-Ribose Binding Proteins; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism; D016019:Survival Analysis
chemical_list: D000951:Antigens, Neoplasm; D004268:DNA-Binding Proteins; D000075223:Poly-ADP-Ribose Binding Proteins; D011960:Receptors, Estrogen; D004250:DNA Topoisomerases, Type II; C000618811:TOP2A protein, human