Prognostic value of different factors in breast carcinoma.

Introduction: The aggressive biological behavior of invasive and metastatic cancer is considered to be the most insidious and life-threatening aspect for breast cancer patients. It is mo- stly the result of changes in many molecular characteristics of tumor cells, including alterations in the mechanisms con- trolling cell growth and proliferation. Aim: The aim of this retrospective study was to identify predic- tors of aggressive biological behavior and metastatic poten- tial in breast carcinoma among a number of intrinsic bio- markers of tumor cells such as steroid receptors and oncoge- ne and tumor suppressor gene products. Methods: Routine formalin-fixed, paraffin-embedded tumor samples were used and sections were stained immunohisto- chemically with the DAKO Strept ABC method to determine the expression of estrogen receptors (ER), progesterone re- ceptors (PgR), HER-2/neu, bcl-2, Ki-67, p53 and nm23 in 192 consecutive breast carcinoma patients. The results of the quantitative immunohistochemical assays were correlated with clinical and histological data such as patient age, overall survival, tumor size, axillary lymph node status, hystological type, tumor grade, Nottingham prognostic index (NPI) and the- rapeutic regimens. Results: Univariate analysis revealed that survival was significan- tly longer for patients with small tumors (P = 0.007), lower tumor grade (P = 0.021), negative axillary lymph nodes (P = 0.002), pre- sence of nm23 protein (P = 0.002), and for patients treated with adjuvant hormonal therapy (P = 0.010). In multivariate analysis the independent factors positively affecting survival were ab- sence of axillary lymph node metastases (P = 0.002), nm23 ex- pression (P = 0.009) and hormonal therapy (P = 0.050). Among patients with positive axillary nodes there was a significantly hi- gher survival rate in patients with nm23 expression compared with nm23-negative patients (P <0.001). Conclusion: Identification of a subset of node-positive breast cancer patients with a more favorable prognosis according to nm23 expression might be clinically useful.