Abstract

<div>Abstract<p><i>BRCA1/2</i> mutations are robust biomarkers for platinum-based chemotherapy in epithelial ovarian cancers. However, <i>BRCA1/2</i> mutations in clear cell ovarian carcinoma (CCC) are less frequent compared with high-grade serous ovarian cancer (HGSC). The discovery of biomarkers that can be applied to CCC is an unmet need in chemotherapy. Schlafen 11 (SLFN11) has attracted attention as a novel sensitizer for DNA-damaging agents including platinum. In this study, we investigated the utility of SLFN11 in HGSC and CCC for platinum-based chemotherapy. SLFN11 expression was analyzed retrospectively by IHC across 326 ovarian cancer samples. The clinicopathologic significance of SLFN11 expression was analyzed across 57 advanced HGSC as a discovery set, 96 advanced HGSC as a validation set, and 57 advanced CCC cases, all of whom received platinum-based chemotherapy. <i>BRCA1/2</i> mutation was analyzed using targeted-gene sequencing. In the HGSC cohort, the SLFN11-positive and <i>BRCA</i> mutation group showed significantly longer whereas the SLFN11-negative and <i>BRCA</i> wild-type group showed significantly shorter progression-free survival and overall survival. Moreover, SLFN11-positive HGSC shrunk significantly better than SLFN11-negative HGSC after neoadjuvant chemotherapy. Comparable results were obtained with CCC but without consideration of <i>BRCA1/2</i> mutation due to a small population. Multivariate analysis identified SLFN11 as an independent factor for better survival in HGSC and CCC. The SLFN11-dependent sensitivity to platinum and PARP inhibitors were validated with genetically modified non-HGSC ovarian cancer cell lines. Our study reveals that SLFN11 predicts platinum sensitivity in HGSC and CCC independently of <i>BRCA1/2</i> mutation status, indicating that SLFN11 assessment can guide treatment selection in HGSC and CCC.</p></div>

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