High-expressed ACAT2 predicted the poor prognosis of platinum-resistant epithelial ovarian cancer

Background: Acetyl-CoA acetyltransferase 2 (ACAT2) is a lipid metabolism enzyme and rarely was researched in epithelial ovarian cancer (EOC). Methods: ACAT2 expressions were confirmed by quantitative real-time polymerase chain reaction and western blotting in SKOV3, SKOV3/DDP, A2780 and A2780/DDP cell lines. Tissue samples were stained by immunohistochemistry and scored for ACAT2 expression. The relationships between ACAT2 expression and clinicopathological characteristics were analyzed by χ 2 test. The prognosis of ACAT2 was analyzed by log-rank tests and Cox regression models. Results: ACAT2 was remarkably upregulated in the above drug-resistant cell lines by mRNA ( P < 0.001) and protein expression ( P < 0.05) than those in sensitive ones. Patients were classified as ACAT2-high (n = 51) and ACAT2-low (n = 26) according to immunohistochemical score. ACAT2 expression had a significantly inverse correlation with FIGO stage ( P = 0.030) and chemo-response ( P = 0.041). A marginal statistical significance existed in ACAT2 expression and ascites volume ( P = 0.092). Univariate analysis suggested that high-expressed ACAT2 was associated with decreased platinum-free interval (PFI) (8.57 vs 14.13 months, P = 0.044), progression-free survival (PFS) (14.12 vs 19.79 months, P = 0.039) and overall survival (OS) (36.89 vs 52.40 months, P = 0.044). Multivariate analysis demonstrated that ACAT2 expression (hazard ratio = 2.18, 95% confidence interval: 1.15 - 4.11, P = 0.017) affected OS independently, rather than PFI and PFS. Significance High-expressed ACAT2 was associated with advanced FIGO stage, chemo-resistance, and decreased PFI, PFS and OS. It was an independent prognostic factor of OS in EOC.