Japanese Journal of Clinical Oncology, Vol 27, Issue 1 6-12, Copyright © 1997 by Foundation for Promotion of Cancer Research
K Iwaya, H Tsuda, T Fukutomi, S Tsugane, M Suzuki and S Hirohashi
Even among breast cancer patients without metastasis to axillary lymph
nodes, early recurrence can occur. To determine the risk factors for early
recurrence, we performed a case-control study between 32 patients with an
early recurrence of breast cancer and 122 patients without recurrence, in
which tumor size, age of patient and date of operation were matched. In all
154 node-negative patients, followed up over a 13.1-year median period,
expression of p53, c-erbB-2 and cathepsin D in the primary tumor were
studied immunohistochemically in paraffin-embedded tissues and were
compared with morphologic factors such as histologic grade and invasive
growth. Univariate analysis showed that nuclear p53 immunoreaction was
significantly predictive of early recurrence [risk ratio (RR) 3.3].
Likewise, cathepsin D (RR 0.22) was significantly negatively associated;
however, when the risk ratio was analyzed in terms of intensity of
cathepsin D staining, no superior survival was found for patients with
strongly positive tumors. Overexpression of c-erbB-2 protein was not
associated with outcome by either univariate or multivariate analysis. As a
whole, histologic grade was confirmed as being a strong predictor (RR 42.6)
and multivariate analysis showed that only histologic grade was a
significant risk factor for early recurrence. p53 immunoreaction was not a
significant independent factor because it was closely linked to histologic
grade (P = 0.002), especially to a high mitotic index (P < 0.001).
Moreover, in 14 patients with "special histologic types' of invasive
carcinomas and no recurrence, all were p53-negative except one medullary
carcinoma. Nuclear p53 immunoreaction is useful in supporting histologic
grade to detect a high-risk for early recurrence in node-negative patients
who may be eligible for systemic adjuvant therapy.
ORIGINAL ARTICLE
Histologic grade and p53 immunoreaction as indicators of early recurrence of node-negative breast cancer
Pathology Division, National Cancer Center Research Institute, Tokyo, Japan.
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