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S, suggesting that its up-regulation was acquired in the course of tumor progression and, in particular, during the acquisition of metastatic potential. Our results showed that miR-27a and ZBTB10 expression were not correlated with receptor status. On the contrary, it was reported that miR-27a indirectly regulates estrogen receptora expression and hormone responsiveness in MCF-7 breast cancer cells through the suppression of ZBTB10 [30]. To understand these conflicting results, the difference between clinical observation and in vitro experiments should be considered. After dividing the Pentagastrin web patients by the cut-off method, a multivariate Cox proportional hazard regression analysis revealed that miR-27a overexpression had a significantly worse prognostic impact (P = 0.003) on the overall survival of breast cancer patients independent of tumor size (P = 0.000). These results indicate that, as an independent risk factor, miR-27a could serve as a prognostic marker for the survival of patients. To date, several studies have revealed the prognostic significance of miR-27a overexpression in various carcinomas, such as gastric cancer [31], acute lymphoblastic leukemia [17] and osteosarcoma [32]. To the best of our knowledge, our research may be the first report to evaluate the prognostic value of miR-27a in breast cancer. Several tumor suppressor genes have been identified as targets of miR-27a regulation, including ZBTB10 [24,33], FOXO1 [34] and prohibitin [10]. By downregulating ZBTB10, miR-27a could increase the expression of the specificity protein (Sp) transcriptionfactors Sp1, Sp3 and Sp4 and several Sp-regulated genes/proteins, including vascular endothelial growth factor, survivin, cyclin D1 and fibroblast growth factor receptor-3. All of these genes encode tumor suppressors that are involved in breast cancer migration and invasion. Correspondingly, miR-27a also plays a role in invasion and metastasis [33,35,36]. Our results showed that expression of miR-27a was lower and the expression of ZBTB10 was higher in the non-metastatic group compared to the metastatic group. Like miR-27a, the difference in the expression of ZBTB10 between metastatic and non-metastatic breast cancers was statistically significant. In addition, Spearman order correlation analysis showed that ZBTB10 expression in breast cancer was 23727046 inversely correlated with the miR-27a level. ZBTB10 levels were KDM5A-IN-1 price closely associated with tumor size, lymph node metastasis and distant metastasis of the patients. This may contribute to the ZBTB10 regulation of Sp, which is related to tumor growth and metastasis. However, we did not find that ZBTB10 had prognostic importance in the multivariate Cox proportional hazard regression analysis. These results suggest that miR-27a promotes tumor growth and metastasis by targeting not only ZBTB10 but also other tumor suppressor genes and that ZBTB10 alone does not demonstrate any prognostic value. In summary, the results of our study indicate that the expression of miR-27a is strongly correlated with the clinical stages and overall survival times of patients with breast cancer, providing evidence that up-regulation of miR-27a might play an important role in the progression of the disease. The study results are consistent with the literature and support the notion that miR-27a is an oncogenic microRNA that induces effects by regulating ZBTB10.AcknowledgmentsWe thank Dr. Zefang Ren for his assistance on the statistical analysis and Xiuying Cui for techni.S, suggesting that its up-regulation was acquired in the course of tumor progression and, in particular, during the acquisition of metastatic potential. Our results showed that miR-27a and ZBTB10 expression were not correlated with receptor status. On the contrary, it was reported that miR-27a indirectly regulates estrogen receptora expression and hormone responsiveness in MCF-7 breast cancer cells through the suppression of ZBTB10 [30]. To understand these conflicting results, the difference between clinical observation and in vitro experiments should be considered. After dividing the patients by the cut-off method, a multivariate Cox proportional hazard regression analysis revealed that miR-27a overexpression had a significantly worse prognostic impact (P = 0.003) on the overall survival of breast cancer patients independent of tumor size (P = 0.000). These results indicate that, as an independent risk factor, miR-27a could serve as a prognostic marker for the survival of patients. To date, several studies have revealed the prognostic significance of miR-27a overexpression in various carcinomas, such as gastric cancer [31], acute lymphoblastic leukemia [17] and osteosarcoma [32]. To the best of our knowledge, our research may be the first report to evaluate the prognostic value of miR-27a in breast cancer. Several tumor suppressor genes have been identified as targets of miR-27a regulation, including ZBTB10 [24,33], FOXO1 [34] and prohibitin [10]. By downregulating ZBTB10, miR-27a could increase the expression of the specificity protein (Sp) transcriptionfactors Sp1, Sp3 and Sp4 and several Sp-regulated genes/proteins, including vascular endothelial growth factor, survivin, cyclin D1 and fibroblast growth factor receptor-3. All of these genes encode tumor suppressors that are involved in breast cancer migration and invasion. Correspondingly, miR-27a also plays a role in invasion and metastasis [33,35,36]. Our results showed that expression of miR-27a was lower and the expression of ZBTB10 was higher in the non-metastatic group compared to the metastatic group. Like miR-27a, the difference in the expression of ZBTB10 between metastatic and non-metastatic breast cancers was statistically significant. In addition, Spearman order correlation analysis showed that ZBTB10 expression in breast cancer was 23727046 inversely correlated with the miR-27a level. ZBTB10 levels were closely associated with tumor size, lymph node metastasis and distant metastasis of the patients. This may contribute to the ZBTB10 regulation of Sp, which is related to tumor growth and metastasis. However, we did not find that ZBTB10 had prognostic importance in the multivariate Cox proportional hazard regression analysis. These results suggest that miR-27a promotes tumor growth and metastasis by targeting not only ZBTB10 but also other tumor suppressor genes and that ZBTB10 alone does not demonstrate any prognostic value. In summary, the results of our study indicate that the expression of miR-27a is strongly correlated with the clinical stages and overall survival times of patients with breast cancer, providing evidence that up-regulation of miR-27a might play an important role in the progression of the disease. The study results are consistent with the literature and support the notion that miR-27a is an oncogenic microRNA that induces effects by regulating ZBTB10.AcknowledgmentsWe thank Dr. Zefang Ren for his assistance on the statistical analysis and Xiuying Cui for techni.

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