A 36-gene Signature Predicts Clinical Progression in a Subgroup of ERG-positive Prostate Cancers

Background: The molecular basis of the clinical heterogeneity of prostate cancer (PCa) is not well understood. Objective: The purpose of our study was to identify and characterize genes in a clinically relevant gene expression signature in a subgroup of primary PCa positive for transmembrane protease, serine 2 (TMPRSS2)-v-ets erythroblastosis virus E26 oncogene homolog (avian) (ERG). Design, setting, and participants: We studied gene expression profiles by unsupervised hierarchical clustering in 48 primary PCas from patients with a long clinical follow-up. Results were correlated with clinical outcome and validated in an independent patient cohort. Selected genes from a defined classifier were tested in vitro for biologic properties. Intervention: Initial treatment of primary tumors was radical prostatectomy. Outcome measurements and statistical analysis: Associations between clinical and histopathologic variables were evaluated by the Pearson chi(2) test, Mann-Whitney U test, or Kruskal-Wallis test, where appropriate. The log-rank test or Breslow method was used for statistical analysis of Kaplan-Meier survival curves. Results and limitations: Most tumors that overexpressed ERG clustered separately from other primary PCas. No differences in any clinical end points between ERG-positive and ERG-negative cancers were detected. Importantly, within the ERG-positive samples, two subgroups were identified, which differed significantly in prostate-specific antigen recurrence-free survival, and cancer-specific and overall survival. From our findings, we defined a gene expression classifier of 36 genes. In a second, com Conclusions: The classifier identified can contribute to prediction of tumor progression in ERG-positive primary prostate tumors and might be instrumental in therapy decisions. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.