The Ewing's sarcoma (ES) family of tumors, including peripheral neuroectodermal
tumor (PNET), is defined genetically by specific chromosomal translocations
resulting in fusion of the EWS gene with a member of the ETS family of
transcription factors, either FLI1 (90-95%) or ERG (5-10%). A second level of
molecular genetic heterogeneity stems from the variation in the location of the
translocation breakpoints, resulting in the inclusion of different combinations
of exons from EWS and FLI1 (or ERG) in the fusion products. The most common type
of EWS-FLI1 fusion transcript, type 1, is associated with a favorable prognosis
and appears to encode a functionally weaker transactivator, compared to other
fusion types. We sought to determine whether the observed covariation of
structure, function, and clinical course correlates with tumor cell kinetic
parameters such as proliferative rate and apoptosis, and with expression of the
receptor for insulin-like growth factor I (IGF-1R). In a group of 86 ES/PNET with
defined EWS-ETS fusions (45 EWS-FLI1 type 1, 27 EWS-FLI1 non-type 1, 14 EWS-ERG),
we assessed proliferation rate by immunostaining for Ki-67 using MIB1 antibody (n
= 85), apoptosis by TUNEL assay (n = 66), and IGF-1R expression by immunostaining
with antibody 1H7 (n = 78). Ki-67 proliferative index was lower in tumors with
EWS-FLI1 type 1 than those with non-type 1 EWS-FLI1, whether analyzed as a
continuous (P = 0.049) or categorical (P = 0.047) variable. Logistic regression
analysis suggests that this association was secondary to the association of type
1 EWS-FLI1 and lower IGF-1R expression (P = 0.04). Comparing EWS-FLI1 to EWS-ERG
cases, Ki-67 proliferative index was higher in the latter (P = 0.01, Mann-Whitney
test; P = 0.02, Fisher's exact test), but there was no significant difference in
IGF-1R. TUNEL results showed no significant differences between groups. Our
results suggest that clinical and functional differences between alternative
forms of EWS-FLI1 are paralleled by differences in proliferative rate, possibly
mediated by differential regulation of the IGF-1R pathway
