Expression of EZH2 and Ki-67 in colorectal cancer and associations with treatment response and prognosis.
BACKGROUND
Enhancer of zeste homologue 2 (EZH2) is a member of the Polycomb group of genes that is involved in epigenetic silencing and cell cycle regulation.


METHODS
We studied EZH2 expression in 409 patients with colorectal cancer stages II and III. The patients were included in a randomised study, and treated with surgery alone or surgery followed by adjuvant chemotherapy.


RESULTS
EZH2 expression was significantly related to increased tumour cell proliferation, as assessed by Ki-67 expression. In colon cancer, strong EZH2 expression (P=0.041) and high proliferation (>or=40%; P=0.001) were both associated with better relapse-free survival (RFS). In contrast, no such associations were found among rectal cancers. High Ki-67 staining was associated with improved RFS in colon cancer patients who received adjuvant chemotherapy (P=0.001), but not among those who were treated by surgery alone (P=0.087). In colon cancers stage III, a significant association between RFS and randomisation group was found in patients with high proliferation (P=0.046), but not in patients with low proliferation (P=0.26). Multivariate analyses of colon cancers showed that stage III (hazard ratio (HR) 4.00) and high histological grade (HR 1.80) were independent predictors of reduced RFS, whereas high proliferation indicated improved RFS (HR 0.55).


CONCLUSIONS
Strong EZH2 expression and high proliferation are associated features and both indicate improved RFS in colon cancer, but not so in rectal cancer.
Department of Oncology, Haukeland University Hospital, Bergen, Norway.
Ø
Ø
Fluge
K
K
Gravdal
E
E
Carlsen
B
B
Vonen
K
K
Kjellevold
S
S
Refsum
R
R
Lilleng
T J
TJ
Eide
T B
TB
Halvorsen
K M
KM
Tveit
A P
AP
Otte
L A
LA
Akslen
O
O
Dahl
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D004268:DNA-Binding Proteins / Q000032:analysis*; D000071221:Enhancer of Zeste Homolog 2 Protein; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063151:Polycomb Repressive Complex 2; D011379:Prognosis; D014157:Transcription Factors / Q000032:analysis*
D004268:DNA-Binding Proteins; D019394:Ki-67 Antigen; D014157:Transcription Factors; C498409:EZH2 protein, human; D000071221:Enhancer of Zeste Homolog 2 Protein; D063151:Polycomb Repressive Complex 2