title: DNA replication licensing factors and aneuploidy are linked to tumor cell cycle state and clinical outcome in penile carcinoma.
abstract: OBJECTIVE
  The DNA replication licensing machinery is integral to the control of proliferation, differentiation, and maintenance of genomic stability in human cells. We have analyzed replication licensing factors (RLF), together with DNA ploidy status, to investigate their role in progression of penile squamous cell carcinoma and to assess their utility as novel prognostic tools.
  
  
  METHODS
  In a cohort of 141 patients, we linked protein expression profiles of the standard proliferation marker Ki67 and the RLFs Mcm2 and geminin to clinicopathologic variables, ploidy status, and clinical outcome.
  
  
  RESULTS
  Increased Ki67, Mcm2, and geminin levels were each significantly associated with arrested tumor differentiation (P < 0.0001) and aneuploidy (P < or = 0.01). Accelerated cell cycle progression was linked to increasing tumor size, stage, and depth of invasion. Aneuploid tumors significantly correlated with tumor grade (P < 0.0001). Biomarker expression and DNA ploidy status were significant predictors of locoregional disease progression [Mcm2 (P = 0.02), geminin (P = 0.02), Ki67 (P = 0.03), and aneuploidy (P = 0.03)] in univariate analysis. Importantly, aneuploidy was a strong independent prognosticator for overall survival (hazard ratio, 4.19; 95% confidence interval, 1.17-14.95; P = 0.03). Used in conjunction with conventional pathologic information, multiparameter analysis of these variables can stratify patients into low- or high-risk groups for disease progression (Harrell's c-index = 0.88).
  
  
  CONCLUSIONS
  Our findings suggest that RLFs and tumor aneuploidy may be used as an adjunct to conventional prognostic indicators, identifying men at high risk of disease progression. Our results also identify the DNA replication initiation pathway as a potentially attractive therapeutic target in penile squamous cell carcinoma.
authors.affiliation: Department of Pathology, University College London, London, United Kingdom.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Kayes
authors.forename: Marco
authors.initials: M
authors.lastname: Loddo
authors.forename: Nimish
authors.initials: N
authors.lastname: Patel
authors.forename: Pranav
authors.initials: P
authors.lastname: Patel
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
authors.forename: Gareth
authors.initials: G
authors.lastname: Ambler
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.forename: Alex
authors.initials: A
authors.lastname: Wollenschlaeger
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
authors.forename: Kai
authors.initials: K
authors.lastname: Stoeber
authors.forename: Gareth H
authors.initials: GH
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000782:Aneuploidy; D002277:Carcinoma / Q000235:genetics* / Q000628:therapy*; D002453:Cell Cycle; D018797:Cell Cycle Proteins / Q000096:biosynthesis; D015331:Cohort Studies; D064248:Geminin; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D064111:Minichromosome Maintenance Complex Component 2; D009687:Nuclear Proteins / Q000096:biosynthesis; D010412:Penile Neoplasms / Q000235:genetics* / Q000628:therapy*; D011003:Ploidies; D016896:Treatment Outcome
chemical_list: D018797:Cell Cycle Proteins; C577995:GMNN protein, human; D064248:Geminin; D019394:Ki-67 Antigen; D009687:Nuclear Proteins; C084859:MCM2 protein, human; D064111:Minichromosome Maintenance Complex Component 2