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. 2018 Mar;93(3):307-320.
doi: 10.1016/j.mayocp.2017.10.023.

MyD88 and TLR4 Expression in Epithelial Ovarian Cancer

Matthew S Block  1 Robert A Vierkant  2 Peter F Rambau  3 Stacey J Winham  2 Philipp Wagner  4 Nadia Traficante  5 Aleksandra Tołoczko  6 Daniel G Tiezzi  7 Florin Andrei Taran  4 Peter Sinn  8 Weiva Sieh  9 Raghwa Sharma  10 Joseph H Rothstein  9 Teresa Ramón Y Cajal  11 Luis Paz-Ares  12 Oleg Oszurek  6 Sandra Orsulic  13 Roberta B Ness  14 Gregg Nelson  15 Francesmary Modugno  16 Janusz Menkiszak  17 Valerie McGuire  18 Bryan M McCauley  2 Marie Mack  19 Jan Lubiński  6 Teri A Longacre  20 Zheng Li  21 Jenny Lester  13 Catherine J Kennedy  22 Kimberly R Kalli  1 Audrey Y Jung  23 Sharon E Johnatty  24 Mercedes Jimenez-Linan  25 Allan Jensen  26 Maria P Intermaggio  27 Jillian Hung  22 Esther Herpel  28 Brenda Y Hernandez  29 Andreas D Hartkopf  4 Paul R Harnett  30 Prafull Ghatage  15 José M García-Bueno  31 Bo Gao  30 Sian Fereday  32 Ursula Eilber  23 Robert P Edwards  33 Christiani B de Sousa  7 Jurandyr M de Andrade  7 Anita Chudecka-Głaz  17 Georgia Chenevix-Trench  24 Alicia Cazorla  34 Sara Y Brucker  4 Australian Ovarian Cancer Study GroupJennifer Alsop  19 Alice S Whittemore  35 Helen Steed  36 Annette Staebler  37 Kirsten B Moysich  38 Usha Menon  39 Jennifer M Koziak  40 Stefan Kommoss  4 Susanne K Kjaer  41 Linda E Kelemen  42 Beth Y Karlan  13 David G Huntsman  43 Estrid Høgdall  44 Jacek Gronwald  6 Marc T Goodman  45 Blake Gilks  46 María José García  47 Peter A Fasching  48 Anna de Fazio  22 Suha Deen  49 Jenny Chang-Claude  50 Francisco J Candido Dos Reis  7 Ian G Campbell  51 James D Brenton  52 David D Bowtell  53 Javier Benítez  47 Paul D P Pharoah  54 Martin Köbel  55 Susan J Ramus  56 Ellen L Goode  57
Collaborators, Affiliations

MyD88 and TLR4 Expression in Epithelial Ovarian Cancer

Matthew S Block et al. Mayo Clin Proc. 2018 Mar.

Abstract

Objective: To evaluate myeloid differentiation primary response gene 88 (MyD88) and Toll-like receptor 4 (TLR4) expression in relation to clinical features of epithelial ovarian cancer, histologic subtypes, and overall survival.

Patients and methods: We conducted centralized immunohistochemical staining, semi-quantitative scoring, and survival analysis in 5263 patients participating in the Ovarian Tumor Tissue Analysis consortium. Patients were diagnosed between January 1, 1978, and December 31, 2014, including 2865 high-grade serous ovarian carcinomas (HGSOCs), with more than 12,000 person-years of follow-up time. Tissue microarrays were stained for MyD88 and TLR4, and staining intensity was classified using a 2-tiered system for each marker (weak vs strong).

Results: Expression of MyD88 and TLR4 was similar in all histotypes except clear cell ovarian cancer, which showed reduced expression compared with other histotypes (P<.001 for both). In HGSOC, strong MyD88 expression was modestly associated with shortened overall survival (hazard ratio [HR], 1.13; 95% CI, 1.01-1.26; P=.04) but was also associated with advanced stage (P<.001). The expression of TLR4 was not associated with survival. In low-grade serous ovarian cancer (LGSOC), strong expression of both MyD88 and TLR4 was associated with favorable survival (HR [95% CI], 0.49 [0.29-0.84] and 0.44 [0.21-0.89], respectively; P=.009 and P=.02, respectively).

Conclusion: Results are consistent with an association between strong MyD88 staining and advanced stage and poorer survival in HGSOC and demonstrate correlation between strong MyD88 and TLR4 staining and improved survival in LGSOC, highlighting the biological differences between the 2 serous histotypes.

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Conflict of interest statement

Potential Competing Interests: The authors report no competing interests.

Figures

FIGURE 1
FIGURE 1
Representative immunohistochemical stains for MyD88 and TLR4 expression. A, High-grade serous carcinoma with weak MyD88 staining. B, High-grade serous carcinoma with weak TLR4 staining. C, High-grade serous carcinoma with strong MyD88 staining. D, High-grade serous carcinoma with strong TLR4 staining. MyD88 = myeloid differentiation primary response gene 88; TLR4 = Toll-like receptor 4.
FIGURE 2
FIGURE 2
Kaplan-Meier overall survival plots by MyD88 expression for the 5 most common invasive ovarian cancer histotypes. A, High-grade serous ovarian cancer (N=2776); B, endometrioid ovarian cancer (N=660); C, clear cell ovarian cancer (N=608); D, mucinous ovarian cancer (N=345); and E, low-grade serous ovarian cancer (N=182). MyD88 = myeloid differentiation primary response gene 88.
FIGURE 3
FIGURE 3
Kaplan-Meier overall survival plots by TLR4 expression for the 5 most common invasive ovarian cancer histotypes. A, High-grade serous ovarian cancer (N=2522); B, endometrioid ovarian cancer (N=612); C, clear cell ovarian cancer (N=561); D, mucinous ovarian cancer (N=303); and E, low-grade serous ovarian cancer (N=145). TLR4 = Toll-like receptor 4.
FIGURE 4
FIGURE 4
Kaplan-Meier overall survival plots by MyD88 and TLR4 expression for the 5 most common invasive ovarian cancer histotypes. A, High-grade serous ovarian cancer (N=2433); B, endometrioid ovarian cancer (N=602); C, clear cell ovarian cancer (N=293); D, mucinous ovarian cancer (N=553); and E, low-grade serous ovarian cancer (N=139). MyD88 = myeloid differentiation primary response gene 88; TLR4 = Toll-like receptor 4.

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