Impact of hemochromatosis gene (HFE) mutations on epithelial ovarian cancer risk and prognosis

Abstract

Cancer cells require large amounts of micronutrients, particularly iron, for their rapid growth and frequent divisions. Cellular iron uptake is regulated by the transferrin receptor and the hemochromatosis protein (HFE) system. Two frequent mutations in the HFE gene, H63D and C282Y, are associated with hemochromatosis type I, an inherited iron overload disease and, possibly, with cancer. In this study, we evaluated the frequency of the H63D and C282Y mutations in a cohort of 677 consecutive cases of woman with gynecological pathologies. Cases included 80 women with tumor-free pathologies normal ovary (NOV), 124 with benign ovarian tumors (BOV), 96 with epithelial ovarian cancer (EOC) tumors of low malignant potential (LPM), 264 with invasive tumors of the ovary (TOV) and 113 with endometrial cancer. We found that the C282Y allele frequency in EOC patients was higher than that in the control NOV group (5.8% vs. 1.3%, p < 0.001) and was associated with an increased risk of ovarian cancer (OR = 4.88; 95% CI 1.15-20.61; p = 0.018). The effect of the two HFE mutations on patient survival was also analyzed. Kaplan-Meier analyses did not find any significant association between the H63D allele and patient survival. However, EOC patients with at least one C282Y allele had a decreased overall survival compared to those with no C282Y allele (p = 0.001). These results indicate that the C282Y mutation may increase the risk of developing ovarian cancer and may be further associated with poor outcomes.

Figure 1

Kaplan-Meier survival curves for the entire group of TOV patients according to HFE genotype. For patients with invasive epithelial ovarian cancer overall survival curves are shown for (a) WT/WT, WT/Y, Y/Y and D/Y patients and (b) WT/WT, WT/D, D/D and D/Y patients. D represents H63D allele. Y represents the C282Y allele. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Figure 2

Kaplan-Meier survival curves for high-grade serous subtype of ovarian cancer patients according to HFE genotype. For patients with high-grade serous subtype ovarian cancer overall survival curves are shown for (a) WT/WT, WT/Y, Y/Y and D/Y patients and (b) WT/WT, WT/D, D/D and D/Y. D represents H63D allele. Y represents the C282Y allele. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]