[Infiltrating ductal carcinomas of the breast in women over 60 years of age. Association with higher cellular proliferation and lower PS2, cell surface and cytosolic hyaluronic acid concentrations]

[Cytosolic pS2 levels and cellular proliferation in ER-positive and PgR-positive infiltrating ductal carcinomas of the breast]

OBJECTIVE

The trefoil factor 1 (TFF1/pS2) is an estrogen-induced molecule in breast tumours. We wanted to study its expression in ER+ and PgR+ infiltrating ductal carcinomas of the breast (IDCs), and to correlate it with other clinical-biological parameters and the outcome.

MATERIAL AND METHODS

Cytosolic pS2 levels were measured using an IRMA (CIS. Biointernational. France) in 170 tumors. Likewise we determined the cytosolic levels of cathepsin D and tissue-type plasminogen activator (t-PA), as well as the concentrations of the epidermal growth factor receptor (EGFR), erbB2 oncoprotein, CD44v5 and CD44v6 on cell surfaces. Also the tumour size, histological grade (HG), axillary lymph node involvement, distant metastasis, ploidy, DNA index and of cellular synthesis phase (SP) was taken in account.

RESULTS

The pS2-positive (> 5 ng/mg prot.) tumours showed higher concentrations of cathepsin D (p: 0.0043) and t-PA (p: 0.0089) than the pS2-negative ones. Likewise, they were less frequently HG3 (p: 0.0231), SP > 7 % (p: 0.0005) and SP > 14% (p:0.0014). During the follow-up time (r: 1-147; 50,1+/-31,7; median 37 months) the pS2-positive tumors showed a less number of recurrences (5/101 vs 6/69; p: 0.059) but not of deaths by the tumor (1/101 vs 2/69).

CONCLUSIONS

These results support an inverse relationship between pS2 positivity and cellular proliferation in IDCs and suggest a new role of this protein (different of the hormone dependence) in the biology of these breast carcinomas, while further studies will be required to establish the impact of this finding on their outcome.

[Clinical and biological differences between infiltrating ductal carcinomas of the breast in women over 70 years-old and those aged 60-70]

BACKGROUND

There is discrepancy in the literature regarding the behavior of breast cancer in elderly women. For this reason we decided to study the possible clinical and biological differences of infiltrative ductal breast carcinoma between women over 70 years and those aged between 60 and 70 years.

PATIENTS AND METHOD

The study group included 181 women with infiltrative ductal carcinomas (IDCs) who were referred from a breast clinic (BC) and a breast cancer screening campaign (BCS). 67 of them were older than 70 and 114 were between 60 and 70 years old. Estrogen receptors (ER), progesterone receptors (PR), pS2 and cathepsin D cytosolic levels were determined, as well as levels of epidermal growth factor receptor (EGFR) in cell surfaces. Likewise, size, axillary lymph node involvement, distant metastasis, histological grade, ploidy and cellular S-phase fraction were also considered as variables of the study.

RESULTS

IDCs in women older than 70 had greater size (p<0.001), global S-phase (p = 0.009) and number of axillary lymph nodes involved (p = 0.002). Likewise, these tumors showed more frequently distant metastasis (p = 0.001) and S-phase values >14% (p = 0.093). However, when we considered only women referred from BCS, no differences in the parameters studied between women older than 70 and those aged between 60 and 70 years were observed. When only patients coming from BC were considered, women older than 70 had a greater number of axillary lymph nodes involved (p= 0.027). Patients older than 70 years from BC showed greater size (p= 0.054) and more common distant metastasis (p= 0.075) than those from BCS. Also, patients between 60 and 70 referred from BC had tumors with greater size (p <0.001), nodal involvement (p= 0.022), number of lymph nodes involved (p= 0.022) and distant metastasis (p= 0.048) than those from BCS with the same age.

CONCLUSIONS

Our results suggest that IDCs in women older than 70 years show clinical and biological features associated with a worse behaviour. However, this is only observed in women referred from BC but not in those coming from BCS. For this reason, the patient's referral site seems to be essential for the observed clinical and biological differences of breast carcinomas in the elderly.