Abstract
In our study, we conducted a case-control study to investigate the association of ERCC1, ERCC2, ERCC3, ERCC4, ERCC5, XPA, XPC and DDB2 gene polymorphisms in the risk of pancreatic cancer. Between May 2012 and May 2014, a total of 246 patients with who were newly diagnosed with histopathologically confirmed primary pancreatic cancer and 246 controls were selected into our study. Genotyping of ERCC1 rs3212986 and rs11615, ERCC2 rs13181, ERCC3 rs4150441, ERCC4 rs6498486, ERCC5 rs873601, XPA rs2808668, XPC rs2228000, XPC rs2228001 and DDB2 rs2029298 were analyzed using polymerase chain reaction (PCR) coupled with restriction fragment length polymorphism (RFLP). By conditional logistic regression analysis, individuals carrying with TT genotype of ERCC1 rs3212986 and GG genotype of ERCC2 rs13181 were associated with increased risk of pancreatic cancer when compared with wide-type genotype, and the adjusted ORs (95% CI) were 2.40 (1.29-4.52) and 2.27 (1.26-4.15), respectively. We found that individuals carrying with GT+TT genotype of ERCC1 rs3212986 and TG+GG genotype of ERCC2 rs1318 gene polymorphisms were correlated with higher risk of pancreatic cancer in smokers when compared with non-smokers, and the adjusted ORs (95% CI) were 1.89 (1.05-3.40) and 1.88 (1.06-3.34), respectively. In conclusion, our study suggests that ERCC1 rs3212986 and ERCC2 rs1318 gene polymorphisms contribute to the development of pancreatic cancer, especially in smokers.
Keywords: DNA repair genes, polymorphism, pancreatic cancer
Introduction
Pancreatic cancer is one of the most fatal malignant tumors worldwide, and this cancer has the highest fatality rates and the fourth-highest mortality rate among both men and women [1,2]. It is estimated that there are 65,727 new cases with pancreatic cancer and 63,662 deaths due to this cancer in China [3]. It is reported that the pancreatic cancer is gradually increasing, and less than 5% patients live 5 years after diagnosis although the advanced in detection and treatment for pancreatic cancer [1]. It is well known that the development of pancreatic cancer is involved in complex and multifactorial process, and this cancer is caused by many environmental factors, such as alcohol drinking, tobacco smoking, overall weight, diabetes mellitus and family history of pancreatic cancers in the first relatives [4,5]. However, not all the individuals who expose to the risk factors would develop pancreatic cancer, which suggests that genetic factors may contribute to the development of this cancer.
Efficient DNA repair plays an important role in preventing the propagation of errors and maintaining genomic stability. There are about 130 genes and several molecular pathways in the repairing of the DNA damages, including nucleotide excision repair (NER), base-excision repair (BER), homologous recombination, and non-homologous end joining [6]. NER pathway is an important DNA repair process involved in maintaining genome integrity, such as damage recognition, damage demarcation and unwinding, damage incision and new strand ligation [7]. ERCC1, ERCC4 and ERCC5 are three important genes involved in the DNA damage incision [8,9], ERCC2 and ERCC3 are two genes and responsible for the damage unwinding process [10,11], and XPA, XPC and DDB2 are involved in the DNA damage recognition [12]. Until now, few studies have been conducted to investigate the role of genes in NER pathways in the development of pancreatic cancer risk. In our study, we conducted a case-control study to investigate the association of ERCC1, ERCC2, ERCC3, ERCC4, ERCC5, XPA, XPC and DDB2 gene polymorphisms in the risk of pancreatic cancer.
Materials and methods
Subjects
Between May 2012 and May 2014, a total of 265 patients with who were newly diagnosed with histopathologically confirmed primary pancreatic cancer were selected from Zhumadian Central Hospital. Patients who had primary tumors other than pancreatic cancer and tumors of an unknown origin were excluded from this study. Finally, 246 patients are according to the inclusion criteria and included into this study, and the participation rate is 92.83%.
The control group consisted of 246 subjects without malignant pathologies consulting at Orthopedics, Dermatology and Pneumology departments in the same hospital. The controls were matched with patients in terms of age and gender.
Cases and controls were interviewed using a standardized questionnaire including socio-demographic characteristics, such as gender, age, tobacco smoking, alcohol drinking, body mass index and type 2 diabetes as well as family history of pancreatic cancer. Tobacco smokers were divided into smokers and non-smokers. Smokers were defined as those who had smoked a pack of cigarettes once a week for more than half a year. Drinkers were defined as those who had drunk alcoholic beverages at least once a week for more than half a year previously. All individuals voluntarily participated in the study and gave their informed consent. The project was approved by the Ethics Committee of Zhumadian Central Hospital.
DNA extraction and SNPs genotyping
5 ml peripheral blood sample was drawn from each patient with pancreatic cancer and control subject, and the peripheral blood samples were kept in -20°C until use. DNA was extracted from peripheral blood samples collected from patients and controls using the conventional phenol/chloroform extraction method. Genotyping of ERCC1 rs3212986 and rs11615, ERCC2 rs13181, ERCC3 rs4150441, ERCC4 rs6498486, ERCC5 rs873601, XPA rs280-8668, XPC rs2228000, XPC rs2228001 and DDB2 rs2029298 were analyzed using polymerase chain reaction (PCR) coupled with restriction fragment length polymorphism (RFLP). The PCR fragments of the investigated polymorphisms were subsequently digested with their specific restriction enzyme. The reaction condition for PCR was conducted at 95°C for 5 min for the initial denaturation, following 30 cycles of denaturation at 95°C for 30 s, annealing at 62°C for 45 s, extension at 72°C for 30 s and final extension at 72°C for 5 mins. Digestion products were separated by electrophoresis on ethidium bromide stained agarose gel and visualized under UV light.
Statically analysis
Means of quantitative variables were compared between groups using Student t-test, while distributions of categorical variables were compared by Pearson χ2 test. Hardy-Weinberg equilibrium (HWE) was examined using a χ2-test with one degree of freedom. Multiple conditional logistic regression models were established to estimate relative risks of tobacco and alcohol consumption as well as risks related to each SNP after adjustment for gender, age, tobacco smoking, alcohol drinking, body mass index and type 2 diabetes as well as family history of pancreatic cancer. Additional regression models were designed where subjects were stratified on demographic characteristics and genetic polymorphisms of the study variations. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. All tests were two-sided with a significant level of P-value <0.05. Statistical analysis was conducted using the SPSS 21.0 package (SPSS Inc., Chicago, IL, USA).
Results
The demographic characteristics of patients with pancreatic cancer and control subjects were summarized in Table 1. The mean ages of patients with pancreatic cancer and control subjects were 57.3±7.9 and 56.8±8.1 years old, respectively. By χ2-test, no significant differences were found between patients with pancreatic cancer and control subjects in terms of age, gender and type 2 diabetes. When compared with control subjects, patients with pancreatic cancer were more likely to be tobacco smokers and alcohol drinkers, and have higher BMI and family history of pancreatic cancer in the first relatives.
Table 1.
Demographic characteristics of patients with pancreatic cancer and control subjects
| Variables | Patients | % | Controls | % | χ2-test | P value |
|---|---|---|---|---|---|---|
| Age, years | ||||||
| ≤55 | 102 | 41.46 | 104 | 42.28 | ||
| >55 | 144 | 58.54 | 142 | 57.72 | 0.03 | 0.86 |
| Gender | ||||||
| Male | 168 | 68.29 | 168 | 68.29 | ||
| Female | 78 | 31.71 | 78 | 31.71 | 0.00 | 1.00 |
| Tobacco smoking | ||||||
| Non-smokers | 114 | 46.34 | 151 | 61.38 | ||
| Smokers | 132 | 53.66 | 95 | 38.62 | 11.20 | 0.001 |
| Alcohol drinking | ||||||
| Non-drinkers | 106 | 43.09 | 141 | 57.32 | ||
| Drinkers | 140 | 56.91 | 105 | 42.68 | 9,96 | 0.002 |
| Body Mass Index (BMI) | ||||||
| ≤24 | 136 | 55.28 | 168 | 68.29 | ||
| >24 | 110 | 44.72 | 78 | 31.71 | 8.82 | 0.003 |
| Type 2 diabetes | ||||||
| No | 39 | 15.85 | 26 | 10.57 | ||
| Yes | 207 | 84.15 | 220 | 89.43 | 2.99 | 0.08 |
| Family history of pancreatic cancer in the first relatives | ||||||
| No | 232 | 94.31 | 246 | 100.00 | ||
| Yes | 14 | 5.69 | 0 | 0.00 | 14.41 | <0.001 |
The genotype distributions of ERCC1 rs3212986 and rs11615, ERCC3 rs4150506, ERCC4 rs6498486, ERCC5 rs873601, XPA rs2808668, XPC rs2228001 and DDB2 rs2029298 confirmed with the Hardy-Weinberg equilibrium in the controls (P value >0.05), but ERCC2 rs13181 and XPC rs2228000 were not (P value <0.05) (Table 2). By χ2-test, there were significant differences between patients with pancreatic cancer and control subjects in terms of genotype distributions of ERCC1 rs3212986 (χ2=9.08, P value =0.011) and ERCC2 rs13181 (χ2=9.23, P value =0.01). By conditional logistic regression analysis, individuals carrying with TT genotype of ERCC1 rs3212986 and GG genotype of ERCC2 rs13181 were associated with increased risk of pancreatic cancer when compared with wide-type genotype, and the adjusted ORs (95% CI) were 2.40 (1.29-4.52) and 2.27 (1.26-4.15), respectively. However, we did not find significant difference association of ERCC1 rs11615, ERCC3 rs4150506, ERCC4 rs6498486, ERCC5 rs873601, XPA rs2808668, XPC rs2228000, XPC rs2228001 and DDB2 rs2029298 with the risk of pancreatic cancer.
Table 2.
Association between DNA gene polymorphisms and risk of pancreatic cancer
| Polymorphisms | Cases | % | Controls | % | HWE | χ2-test | P value | Adjusted OR (95% CI)1 | P value |
|---|---|---|---|---|---|---|---|---|---|
| ERCC1 rs3212986 | |||||||||
| GG | 80 | 32.52 | 105 | 42.68 | 1.0 (Ref.) | - | |||
| GT | 124 | 50.41 | 118 | 47.97 | 1.38 (0.92-2.07) | 0.10 | |||
| TT | 42 | 17.07 | 23 | 9.35 | 0.21 | 9.08 | 0.011 | 2.40 (1.29-4.52) | 0.003 |
| ERCC1 rs11615 | |||||||||
| CC | 111 | 45.12 | 120 | 48.78 | 1.0 (Ref.) | - | |||
| CT | 108 | 43.90 | 104 | 42.28 | 0.94 | 0.94 | 0.63 | 1.12 (0.76-1.66) | 0.54 |
| TT | 27 | 10.98 | 22 | 8.94 | 1.33 (0.68-2.60) | 0.37 | |||
| ERCC2 rs13181 | |||||||||
| TT | 131 | 53.25 | 159 | 64.63 | 1.0 (Ref.) | - | |||
| TG | 72 | 29.27 | 64 | 26.02 | 1.37 (0.89-2.10) | 0.13 | |||
| GG | 43 | 17.48 | 23 | 9.35 | <0.001 | 9.23 | 0.01 | 2.27 (1.26-4.15) | 0.003 |
| ERCC3 rs4150506 | |||||||||
| GG | 90 | 36.59 | 96 | 39.02 | 1.0 (Ref.) | - | |||
| GA | 115 | 46.75 | 112 | 45.53 | 1.10 (0.73-1.64) | 0.65 | |||
| AA | 41 | 16.67 | 38 | 15.45 | 0.57 | 0.32 | 0.85 | 1.15 (0.66-2.02) | 0.60 |
| ERCC4 rs6498486 | |||||||||
| AA | 125 | 50.81 | 133 | 54.07 | 1.0 (Ref.) | - | |||
| AC | 94 | 38.21 | 90 | 36.59 | 1.11 (0.75-1.65) | 0.58 | |||
| CC | 27 | 10.98 | 23 | 9.35 | 0.18 | 0.66 | 0.72 | 1.25 (0.65-2.41) | 0.47 |
| ERCC5 rs873601 | |||||||||
| GG | 105 | 42.68 | 118 | 47.97 | 1.0 (Ref.) | - | |||
| GA | 111 | 45.12 | 107 | 43.50 | 1.17 (0.79-1.72) | 0.42 | |||
| AA | 30 | 12.20 | 21 | 8.54 | 0.64 | 2.42 | 0.30 | 1.61 (0.83-3.13) | 0.13 |
| XPA rs2808668 | |||||||||
| TT | 85 | 34.55 | 95 | 38.62 | 1.0 (Ref.) | - | |||
| TC | 132 | 53.66 | 126 | 51.22 | 1.17 (0.79-1.75) | 0.42 | |||
| CC | 29 | 11.79 | 25 | 10.16 | 0.07 | 0.99 | 0.61 | 1.30 (0.67-2.50) | 0.40 |
| XPC rs2228000 | |||||||||
| CC | 119 | 48.37 | 131 | 53.25 | 1.0 (Ref.) | - | |||
| CT | 95 | 38.62 | 85 | 34.55 | 1.23 (0.82-1.84) | 0.29 | |||
| TT | 32 | 13.01 | 30 | 12.20 | <0.001 | 1.20 | 0.55 | 1.17 (0.65-2.13) | 0.57 |
| XPC rs2228001 | |||||||||
| AA | 117 | 47.56 | 127 | 51.63 | 1.0 (Ref.) | - | |||
| AC | 109 | 44.31 | 106 | 43.09 | 1.12 (0.76-1.64) | 0.56 | |||
| CC | 21 | 8.54 | 13 | 5.28 | 0.13 | 2.33 | 0.31 | 1.75 (0.79-3.99) | 0.13 |
| DDB2 rs2029298 | |||||||||
| GG | 100 | 40.65 | 112 | 45.53 | 1.0 (Ref.) | - | |||
| GA | 110 | 44.72 | 104 | 42.28 | 1.18 (0.80-1.76) | 0.38 | |||
| AA | 36 | 14.63 | 30 | 12.20 | 0.44 | 1.39 | 0.50 | 1.34 (0.74-2.44) | 0.30 |
Adjusted for sex, age, tobacco smoking, alcohol drinking, body mass index and family history of pancreatic cancer in the first relatives.
We further analyzed the association between ERCC1 rs3212986 and ERCC2 rs1318 gene polymorphisms and risk of pancreatic cancer stratified by tobacco smoking and alcohol drinking (Table 3). We found that individuals carrying with GT+TT genotype of ERCC1 rs3212986 and TG+GG genotype of ERCC2 rs1318 gene polymorphisms were correlated with higher risk of pancreatic cancer in smokers when compared with non-smokers, and the adjusted ORs (95% CI) were 1.89 (1.05-3.40) and 1.88 (1.06-3.34), respectively.
Table 3.
Interaction between ERCC1 rs3212986 and ERCC2 rs1318 gene polymorphisms and tobacco smoking and alcohol drinking in the risk of pancreatic cancer
| ERCC1 rs3212986 | OR (95% CI)1 | P value | ERCC2 rs1318 | OR (95% CI) | P value | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|||||||||||
| GG | GT+TT | TT | TG+GG | |||||||||
|
|
|
|||||||||||
| Patients | Controls | Patients | Controls | Patients | Controls | Patients | Controls | |||||
| Tobacco smoking | ||||||||||||
| Non-smokers | 41 | 63 | 73 | 88 | 1.27 (0.75-2.17) | 0.34 | 68 | 99 | 46 | 52 | 1.29 (0.76-2.19) | 0.32 |
| Smokers | 39 | 42 | 93 | 53 | 1.89 (1.05-3.40) | 0.02 | 63 | 60 | 69 | 35 | 1.88 (1.06-3.34) | 0.02 |
| Alcohol drinking | ||||||||||||
| Non-drinkers | 35 | 60 | 71 | 81 | 1.50 (0.86-2.63) | 0.13 | 56 | 91 | 50 | 50 | 1.63 (0.94-2.81) | 0.06 |
| Drinkers | 45 | 45 | 95 | 60 | 1.58 (0.91-2.77) | 0.09 | 75 | 68 | 65 | 37 | 1.59 (0.92-2.78) | 0.08 |
Adjusted for sex, age, body mass index and family history of pancreatic cancer in the first relatives.
Discussion
Polymorphisms have an effect on the regulation of gene expression, and they can contribute to the differences between individuals in the susceptibility to a disease and its severity. The regulation of DNA repair plays an important role in the multistep process of carcinogenesis, and NER pathway is an important DNA repair process, and it has steps of damage recognition, damage demarcation and unwinding, damage incision, and new strand ligation [13,14]. Polymorphisms in DNA repair genes resulting in variation of DNA repair efficiency may therefore be associated with risk of cancers. In the present study, we investigate the role of ERCC1, ERCC2, ERCC3, ERCC4, ERCC5, XPA, XPC and DDB2 gene polymorphisms of the NER pathway in the risk of pancreatic cancer, and we found that ERCC1 rs3212986 and ERCC2 rs1318 gene polymorphisms contribute to the development of pancreatic cancer.
The excision repair cross complementation group 1 (ERCC1) enzyme belongs to nucleotide excision repair (NER) system which has the ability of repairing DNA adducts and other DNA helix-distorting lesions [15]. ERCC1 has interaction with XPA, XPF and/or RPA, guiding the 5’ cleavage activity in the NER pathway [16,17]. Cells from ERCC1-deficient mice show a high mutation frequency, an elevated level of genomic instability and a reduced frequency of S-phase-dependent illegitimate chromosome exchange, a response adopted by rodent cells to prevent the accumulation of DNA double strand breaks [18]. Therefore, functional SNPs in ERCC1 could influence cellular DNA repair capacity and thus may be important for the development of cancers. Previous studies have reported that the ERCC1 rs3212986 polymorphism is associated with development of several kinds of cancer, such as colorectal cancer, lung cancer, breast cancer and glioma [19,22]. A recent meta-analysis with 48 case-control studies reported that no association between ERCC1 rs3212986 and susceptibility to cancers [23]. For the association between ERCC1 rs3212986 polymorphism and risk of pancreatic cancer, only study reported that ERCC1 rs3212986 polymorphism could not influence the development of pancreatic cancer [24]. However, we found that ERCC1 rs3212986 was associated with an increased risk of pancreatic cancer. The discrepancy of the different results may be caused by different in ethnicities, study design, source of patients, sample size, and by chance.
The ERCC2 protein, encoded by the gene located at chromosome 19q13.3, possesses both single strand DNA-dependent ATPase and 5’-3’ DNA helicase activities and participates in DNA unwinding during NER [25,26]. Polymorphisms in the ERCC2 gene are thought to reduce the helicase activity, resulting in a lower DNA repair capacity of NER pathway and influencing cancer susceptibility [27,28]. Previous studies have reported that ERCC2 rs1318 gene polymorphism is associated with many kinds of cancers, such as esophageal cancer, hepatocellular cancer, skin cancer and breast cancer [29-32]. Two studies reported the association between ERCC2 rs1318 gene polymorphism and pancreatic cancer [33,34]. Jiao et al. reported that ERCC2 rs1318 gene polymorphism could be a genetic risk modifier for smoking-related pancreatic cancer in a Chinese population [33]. Duell et al. also found that ERCC2 rs1318 gene polymorphism in combination with cigarette smoking may increase the risk for pancreatic cancer [34]. In our study, we found that ERCC2 rs1318 gene polymorphism influence the development of pancreatic cancer, especially in smokers, which are in line with previous studies.
There were several limitations in our study. First, ERCC2 rs13181 and XPC rs2228000 were not in line with Hardy-Weinberg equilibrium, which suggest that the controls may not present the general population. Second, cases and controls were selected from one hospital, selection bias may be considered in our study. Third, tobacco smoking and alcohol drinking were recalled by included subjects, and information bias may be existed. Fourth, the sample size of this study is relatively small, and small sample size may limit the statistical power to find differences between groups.
In conclusion, our study suggests that ERCC1 rs3212986 and ERCC2 rs1318 gene polymorphisms contribute to the development of pancreatic cancer, especially in smokers. Further large sample studies are greatly warranted to elucidate our finding.
Disclosure of conflict of interest
None.
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