First application of the Automated QUantitative Analysis (AQUA) technique to quantify PTEN protein expression in ovarian cancer: A correlative study of NCIC CTG OV.16

•AQUA is a viable option to measure protein expression in OC.•PTEN quantification by AQUA associates with clinical and treatment outcomes in OC.•Integration of PTEN expression as a biomarker requires study in select OC patients.

BackgroundPlatinum resistance is a dominant cause of poor outcomes in advanced ovarian cancer (OC). A mechanism of platinum resistance is the inhibition of apoptosis through phosphatidylinositol 3 kinase (PI3K) pathway activation. The role of phosphatase and tensin homolog (PTEN), a negative regulator of this pathway, as a tumor biomarker is unclear. Quantitative analysis of PTEN expression as an alternative to immunohistochemistry has not been considered.Patients and methodsIn 238 patient tumors from the NCIC-CTG trial OV.16, PTEN protein expression was quantified by Automated QUantitative Analysis (AQUA). Cox model was used to study the association between PTEN expression and clinical outcomes using a minimum p-value approach in univariate analysis. Multivariate analysis was used to adjust for clinical and pathological parameters.ResultsPTEN scores (range 13.9–192.3) of the 202 samples that passed quality control were analyzed. In univariate analysis, there was a trend suggesting an association between PTEN expression by AQUA as a binary variable (low ≤ 61 vs high > 61) and progression free survival (HR = 0.77, p = 0.083), and in multivariate analysis, this association approached significance (HR = 0.74, p = 0.059). The relationship between quantitative PTEN expression and PFS differed (p = 0.01 for interaction) by the extent of surgical debulking (residual disease (RD) < 1 cm or ≥ 1 cm), with a numerically superior PFS in patients with high PTEN (23.5 vs 14.9 m) only when RD < 1 cm (p = 0.19). There was no association between PTEN levels and overall survival.ConclusionsAQUA is a novel method to measure PTEN expression. Further study of PTEN as a biomarker in OC is warranted.