TY - JOUR

T1 - Evidence for a time-dependent association between FOLR1 expression and survival from ovarian carcinoma

T2 - implications for clinical testing. An Ovarian Tumour Tissue Analysis consortium study

AU - Köbel, M

AU - Madore, J

AU - Ramus, S J

AU - Clarke, B A

AU - Pharoah, P D P

AU - Deen, S

AU - Bowtell, D D

AU - Odunsi, K

AU - Menon, U

AU - Morrison, C

AU - Lele, S

AU - Bshara, W

AU - Sucheston, L

AU - Beckmann, M W

AU - Hein, A

AU - Thiel, F C

AU - Hartmann, A

AU - Wachter, D L

AU - Anglesio, M S

AU - Høgdall, E

AU - Jensen, A

AU - Høgdall, C

AU - Kalli, K R

AU - Fridley, B L

AU - Keeney, G L

AU - Fogarty, Z C

AU - Vierkant, R A

AU - Liu, S

AU - Cho, S

AU - Nelson, G

AU - Ghatage, P

AU - Gentry-Maharaj, A

AU - Gayther, S A

AU - Benjamin, E

AU - Widschwendter, M

AU - Intermaggio, M P

AU - Rosen, B

AU - Bernardini, M Q

AU - Mackay, H

AU - Oza, A

AU - Shaw, P

AU - Jimenez-Linan, M

AU - Driver, K E

AU - Alsop, J

AU - Mack, M

AU - Koziak, J M

AU - Steed, H

AU - Ewanowich, C

AU - DeFazio, A

AU - Kjær, S K

AU - AOCS Study Group

PY - 2014/12

Y1 - 2014/12

N2 - BACKGROUND: Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa.METHODS: Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival.RESULTS: FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94).CONCLUSIONS: FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.

AB - BACKGROUND: Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa.METHODS: Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival.RESULTS: FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94).CONCLUSIONS: FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.

KW - Disease-Free Survival

KW - Female

KW - Folate Receptor 1

KW - Humans

KW - Immunohistochemistry

KW - Middle Aged

KW - Neoplasms, Glandular and Epithelial

KW - Ovarian Neoplasms

KW - Survival Analysis

KW - Tissue Array Analysis

KW - Tumor Markers, Biological

U2 - 10.1038/bjc.2014.567

DO - 10.1038/bjc.2014.567

M3 - Journal article

C2 - 25349970

VL - 111

SP - 2297

EP - 2307

JO - The British journal of cancer. Supplement

JF - The British journal of cancer. Supplement

SN - 0007-0920

IS - 12

ER -