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2016, Volume 32, Number 2, Page(s) 070-081     
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DOI: 10.5146/tjpath.2015.01344
Prognostic Value of ALDH1, EZH2 and Ki-67 in Astrocytic Gliomas
Shimaa AHMED1, Hayam RASHED1, Abdelmonem HEGAZY2, Abdel Motaleb MOHAMED3, Wael ELMESALLAMY4
1Department of Pathology, Zagazig University, Faculty of Medicine, ZAGAZİG, EGYPT
2Department of Anatomy and Embryology, Zagazig University, Faculty of Medicine, ZAGAZİG, EGYPT
3Department of Clinical Oncology and Nuclear Medicine, Zagazig University, Faculty of Medicine, ZAGAZİG, EGYPT
4Department of Neurosurgery, Zagazig University, Faculty of Medicine, ZAGAZİG, EGYPT
Keywords: Astrocytoma, Immunohistochemistry, ALDH1, EZH2, Ki-67

Objective: Tumor stem cells have been found in a variety of neoplasms and stated to have a role in tumor progression. This study aimed to evaluate the prognostic significance of biomarkers which are said to be related to these cells, i.e., EZH2, ALDH1 and Ki-67, and their correlation with each other in astrocytic gliomas.

Material and Method: Formalin-fixed, paraffin-embedded tissue specimens of 40 patients with astrocytic glioma who underwent initial surgery during the period from December 2011 to May 2014 at Zagazig University Hospitals were enrolled in the study. Consecutive 4-μm thick sections from formalin-fixed, paraffin-embedded tissue blocks were prepared and stained with hematoxylin and eosin for histopathological evaluation. Immunohistochemical analysis using ALDH1, EZH2 and Ki-67 antibodies were performed to examine the cases.

Results: A total of forty patients; 22 males and 18 females were studied. The lesions were classified as follows: 14 cases of low-grade astrocytoma (WHO grade I or II), 11 cases of anaplastic astrocytoma (WHO grade III), and 15 glioblastomas (WHO grade IV). There was a significant increase in ALDH1 immunoreactivity with increasing the grade of astrocytoma (mean ±SD = 0.2 ±0.4, 0.5 ±0.6, 1.1 ±1.3 and 2.95 ±2.97 in grade I to IV astrocytic gliomas, respectively). This expression was significantly correlated with overall survival (OS) and progression-free survival (PFS) (P=0.004). EZH2 expression was also significantly associated with advanced grades (mean ±SD =1.35 ±0.4, 3.1 ±2.6, 7.2 ±3.5 and 9.9 ±4.1, in grade I to IV astrocytic gliomas, respectively). EZH2 and Ki-67 expressions were found to be correlated with OS and PFS (P < 0.001).

Conclusion: Increased expression of ALDH1, EZH2 and KI67 are found to be associated with unfavourable prognosis in patients with astrocytic gliomas and may predict therapeutic modalities.

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