Prognostic Factors in Breast Cancer

Evaluation of anti-epithelial-mesenchymal transition property of Garcinia mangostana rind extract

Background

Epithelial-mesenchymal transition (EMT) helps solid tumors to lose their intercellular adhesive property and drives metastasis. As mangosteen fruit is known for many beneficial effects including antimicrobial, antioxidant, and anti-tumorigenic properties and has been used widely in traditional medicine, we interrogated its possible anti-metastatic effect on MCF-7 breast cancer cells.

Results

We found that aqueous mangosteen rind extract (MRE) inhibited growth of MCF-7 and altered the transcript levels of ERα, ERβ, and EGFR genes. Additionally, the MRE changed the expression of important markers of EMT, E-Cadherin, N-Cadherin, Snail, and MMP-9. Moreover, MRE inhibited migration of MCF-7 cells.

Conclusion

The results suggest that MRE suppresses growth and inhibits epithelial-mesenchymal transition in MCF-7 cells.

Breast cancer in Ghanaian women: what has changed?

OBJECTIVES

To evaluate breast cancer in Ghanaian women and to compare these findings with those of previous studies by using histopathologic data.

METHODS

A review of all breast cancer specimens from January 2005 through December 2009 in our institution was conducted.

RESULTS

Of 4,109 female breast specimens reviewed, 1,342 (32.7%) were malignant. Mean (SD) patient age was 50.3 (13.3) years, and mean size of the primary tumors was 4.5 cm. Eighteen (1.3%) specimens were malignant phyllodes tumors. Significant positive associations were found between size of the primary tumor and histologic type (P = .01), histologic grade (P = .001), nodal involvement (P < .001), and TNM stage (P < .001).

CONCLUSIONS

More than 3 decades after the first publication of breast cancer in Ghanaian women, patients are still presenting with large clinically and histologically advanced invasive cancers.

Effects of celecoxib and ly117018 combination on human breast cancer cells in vitro

Activation and signalling of estrogen receptor (ER) and COX-2 represent two important pathways in breast cancer cell regulation. Activation of either pathway is associated with breast cancer cell proliferation and eventually malignant progression. Raloxifene analogue, Ly117018, a selective estrogen receptor modulator and celecoxib, a specific COX-2 inhibitor have been shown to inhibit breast cancer cell proliferation when used alone in vitro and in vivo. In this study, the combined drug effects on hormone-dependent MCF-7 and hormone-independent MDA-MB-435 cells in vitro were evaluated. Cell proliferation assays excluded drug antagonism and revealed a moderate synergistic growth inhibitory activity of Ly117018 and celecoxib on both cell lines when combined in specific concentrations. Growth inhibition of either compound was not associated with cell cycle arrest. In MCF-7 cells, western blot analysis revealed a decreased phosphorylation of the AKT protein by either agent alone or in combination. In MDA-MB-435 cells, celecoxib alone induced an increase in AKT phosphorylation relative to total AKT protein; this effect was decreased in the presence of Ly117018. These results indicate that these two drugs are non-antagonistic; and when combined in specific concentrations, moderate synergistic antiproliferative activity of celecoxib and Ly117018 were observed in hormone-dependent MCF-7 and hormone-independent MDA-MB-435 cells associated with changes in cell cycle distribution and regulation of AKT protein and phosphorylation. These findings further support a central role of the ER- and COX-2 pathways in human breast cancer cells.

Lymph node-based prognostics: limitations with individualized cancer treatment

OBJECTIVES

Clinicians will commonly individualize adjuvant cancer therapy, on the basis of the number of involved lymph nodes and other clinicopathological factors, under the assumption that despite the expected statistical variability of such data one can nonetheless garner useful information for the individual case. Here the scientific basis of this assumption will be examined.

METHODS

Survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for 19,107 breast, 4,234 gastric, and 4,058 rectal cancers were studied with Kaplan-Meier estimates and Cox proportionate hazard models. The minimal sample size required to discriminate between high and low-risk groups was determined from the hazard ratios between various comparative groups, and their respective frequencies.

RESULTS

The number of involved nodes was the strongest prognostic factor for all 3 cancers, followed by tumor diameter and grade. Discrimination between high and low-risk nodal prognostic groups required samples of 30 to 200 cases, depending on the prognostics used and the specific tumor, to attain a two-sided alpha of 0.05% with 90% power. At the individual level such prognostications therefore were uninformative.

CONCLUSIONS

Clinicopathological prognostics based upon the number of involved lymph nodes are subject to population heterogeneity that limits their application to large samples. At the individual level, these prognostics appear more spurious than useful. The use of such prognostics to tailor cancer treatment to individuals should be considered a specious practice; instead a more categorical approach, based on the results of randomized trials, should be used.

MTA1 overexpression correlates significantly with tumor grade and angiogenesis in human breast cancers

Metastasis associated antigen 1 (MTA1) is a recently identified candidate metastasis-associated gene that plays an important role in tumorigenesis and tumor aggressiveness, especially tumor invasiveness and metastasis. We analyzed the relationship between MTA1 expression and variable clinicopathological features and characterized its role in tumor angiogenesis in human breast cancers. Two hundred and sixty-three breast cancer cases that successfully underwent surgery at Hanyang University Hospital (Seoul, Korea) between January 1989 and December 1997 were enrolled. MTA1 expression was observed by immunohistochemical staining and correlated with intratumoral microvessel density (MVD) and other clinicopathological parameters. MTA1 overexpression correlated significantly with higher tumor grade (grades 1 and 2 vs grade 3, P = 0.009). However, MTA1 expression did not correlate with tumor stage, status of estrogen and progesterone receptors, or axillary lymph node metastasis. Interestingly, MTA1 expression was found to correlate significantly with tumor MVD (P = 0.002). Survival analysis did not show a significant difference between MTA1 overexpression and poorer survival. In conclusion, MTA1 overexpression was found to be closely associated with higher tumor grade and increased tumor angiogenesis. These findings suggest MTA1 as a predictor of aggressive phenotype and a possible target molecule for anti-angiogenic drugs in breast cancer treatment.

A prognostic index for operable, node-negative breast cancer

Clinical data and samples from patients diagnosed, more than 10 years previously, with operable node-negative breast cancer (participants in the Scottish Adjuvant Tamoxifen trial), were revisited. Cases with two distinct categories of outcome were selected; more than 10 years disease-free survival ('good outcome') or distant relapse within 6 years of diagnosis ('poor outcome'). An initial set of cases was analysed for a range of putative prognostic markers and a prognostic index, distinguishing the two outcome categories, was calculated. This index was then validated by testing its predictive power on a second, independent set of cases. A combination of histological grade plus immunochemical staining for BCL-2, p27 and Cyclin D1, generated a useful prognostic index for tamoxifen-treated patients but not for those treated by surgery alone. The value of the index was confirmed in a second set of tamoxifen-treated, early stage breast cancers. Overall, it correctly predicted good and poor outcome in 79 and 74% of cases, respectively (odds ratio 11.0). Other markers assessed added little to prediction of outcome. In the case of molecular assays, sensitivity and reliability were compromised by the age of the tissue specimens and the variability of fixation protocols. In selecting patients for adjuvant systemic chemotherapy, the proposed index improves considerably on current international guidelines and matches the performance reported for 'gene-expression signature' analysis.

An efficient route for the preparation of a 21-fluoro progestin-16 alpha,17 alpha-dioxolane, a high-affinity ligand for PET imaging of the progesterone receptor

Two different synthetic routes were explored for the synthesis of fluoro furanyl norprogesterone (FFNP) 1, a high-affinity ligand for the progesterone receptor (PgR) that is being developed as a PET imaging agent for PgR-positive breast cancer. Both approaches proceed through a key intermediate, triol 5. The first approach, starting from keto-ketal 2, employed a dioxenyl group as a synthon for installing a corticosteroid side chain in keto-alcohol 4. The second approach, starting from propargylic acetate 12b, involved the application of a two-step method, a Pd(II)-catalyzed oxidative rearrangement followed by a base-catalyzed acetate rearrangement of the intermediate unsaturated acetate 13b, to generate the requisite corticosteroid side chain in keto-acetate 14b. This intermediate was further elaborated to the final product 1 via efficient dihydroxylation with potassium permangnate, furan acetalization with scandium triflate, and mesylation and fluorination reactions. The palladium-catalyzed route is considerably more efficient than the dioxene approach for the synthesis of key intermediate triol 5, and the scandium triflate-catalyzed acetalization, in particular, led to a considerable improvement in the overall yield of the endo furan acetal alcohol 16a. This route provides a major improvement in the overall yield of the final progestin target, FFNP 1.

Steroid receptor heterogeneity in relation to DNA index in breast cancer: a multiparameter flow cytometric approach on paraffin-embedded tumor samples

Steroid hormone (estrogen and progesterone) receptor (ER and PR) status at the time of breast carcinoma surgery is used as a marker for hormone dependency to guide adjuvant therapy. In a significant number of cases a discrepancy exists between the detected number of hormone receptors and the response to hormonal therapy. One of the explanations for this could be intratumoral heterogeneity. Our objective was to investigate the heterogeneity of steroid hormone receptor expression in breast cancer by using multiparameter flow cytometry (MP-FCM) on routinely processed formalin-fixed, paraffin-embedded tumors. A series of 232 routinely processed breast carcinomas were analyzed using a recently developed technique for the isolation of single cells from paraffin-embedded material. After dewaxing and rehydrating, 50-microm thick sections were heated for 2 hours at 80 degrees C in a citrate solution. Single-cell suspensions were prepared by a short pepsin digestion. The obtained single-cell suspensions were immunostained simultaneously for cytokeratin and ER or PR. Finally, DNA was stained using propidium iodide, after which the samples were analyzed on a flow cytometer. The fractions of ER- and PR-positive cells were determined in the total, as well as the G0 /G1 fraction of the diploid, and in case of nondiploid tumors, also in the G0 /G1 fraction of the aneuploid cell population. Of 232 cases, 88 (38%) were diploid, 38 (16%) were tetraploid, and 106 (46%) were aneuploid. In the diploid tumors the mean fraction of ER- and PR-positive cells was 81% and 76%, respectively. The ER- and PR-positive fractions in the total cytokeratin-positive fraction decreased significantly in the tetraploid (56% and 55%, respectively) and aneuploid tumors (both 47%, p < 0.0001). When analyzing the ER- and PR-positive fractions separately in the diploid and aneuploid cell populations of the nondiploid tumors, it became apparent that the ER and PR status in the diploid fraction of the tumor was significantly higher than in the aneuploid fraction (p < 0.0001). For the tetraploid tumors the mean ER- and PR-positive fractions were 79% and 76%, respectively, in the diploid fraction, and this decreased to 45% in the aneuploid cell subpopulation. In the aneuploid tumors this decrease was even more drastic: in the diploid cell population the ER- and PR-positive fractions were 66% and 62%, while this was 38% and 39% in the aneuploid population. These findings illustrate clearly the existence of a heterogeneous distribution of ER/PR expression in breast cancer, related to the loss of a diploid DNA index. Because of its objective quantification of subfractions within the same tumor, MP-FCM can be regarded as a superior method compared to more conventional techniques such as immunohistochemistry and biochemistry.

Clinical relevance of T1-S, an oncogene-inducible, secreted glycoprotein of the immunoglobulin superfamily, in node-negative breast cancer

Axillary lymph node-negative breast cancer patients have a low risk for disease recurrence, and the majority of these patients are cured by surgery alone. However, accurate identification of that 30% of node-negative patients who are at high-risk for relapse and who might therefore benefit from adjuvant systemic therapy has not been possible using traditional histomorphological and clinical prognostic factors alone. Identification of novel tumor-associated molecules may therefore provide a basis for a better understanding of and eventually for an interference with disease progression. We have recently reported on tumor-associated RNA up-regulation of the secreted, soluble T1-S receptor in node-negative breast cancer. In the present study we analyzed the tumor-associated level of the T1-S receptor using semiquantitative immunohistochemistry in a collective of 102 node-negative breast carcinomas to study its clinical relevance. A high T1-S immunoreactivity score indicating T1-S overexpression was observed in 58 of 102 (57%) cases. The T1-S score was independent of the tumor size, type, grade, steroid hormone receptor status, and the proliferation rate determined by monoclonal antibody against KI-67 protein (MIB1) immunohistochemistry. In univariate and multivariate analysis of disease-free survival, a high T1-S score (p = 0.003) and a low MIB1 score (p = 0.001) were the only parameters that were highly significantly associated with an improved disease-free survival period. We conclude that T1-S receptor overexpression is a novel and independent tumor biological factor that may be associated with reduced progression of lymph node-negative breast cancer.

Differential posttranscriptional regulation of androgen receptor gene expression by androgen in prostate and breast cancer cells

Androgens, via the androgen receptor (AR), modulate the growth and proliferation of prostate and breast cancer cells. However, the molecular mechanisms underlying the regulation of AR gene expression by androgen in these cells remain to be fully elucidated. To explore differences in AR gene expression between these hormone-responsive tumor cell types, we studied androgen-responsive LNCaP prostate cancer and AR positive MDA453 breast cancer cells. Dihydrotestosterone (DHT) 10 nM increased LNCaP cell proliferation and the proportion of LNCaP cells in S-phase of the cell cycle but inhibited MDA453 cell proliferation and reduced the proportion of MDA453 cells in S-phase of cell cycle. In both these cell lines, DHT decreased total AR messenger RNA (mRNA) but increased AR protein. In LNCaP cells, DHT down-regulated AR mRNA transcription but stabilized AR mRNA. In contrast, in MDA453 cells, DHT had no effect on AR mRNA transcription but destabilized AR mRNA. In summary, transcriptional down-regulation induced by androgens in LNCaP cells results in down-regulation of steady-state AR mRNA despite an androgen-induced increase in AR mRNA stability. However, in MDA453 cells, posttranscriptional destabilization of AR mRNA appears to be the predominant mechanism resulting in down-regulation of AR mRNA by androgen. These results demonstrate cell-specific and divergent regulation of AR mRNA turnover by androgen and identify a novel pathway of androgen-induced posttranscriptional destabilization and down-regulation of AR mRNA in human breast cancer cells. Furthermore, these data establish an important role for posttranscriptional pathways in the regulation of AR gene expression by androgen in human prostate and breast cancer cells.

High-dose therapy with peripheral blood stem cell (PBSC) support using an innovative mobilization regimen in patients with high-risk primary or chemoresponsive metastatic breast cancers

High-dose therapy followed by peripheral blood stem cell (PBSC) support was performed in 29 patients with primary high-risk (Group I) or chemoresponsive metastatic (Group II) breast cancer patients. Group I patients had received PBSC mobilization within 4 weeks of modified radical mastectomy. Group II patients had to achieve minimal residual disease (MRD) by induction chemotherapy before being considered eligible for PBSC mobilization and high-dose therapy. An innovative FE120C regimen (5-FU 600 mg/m2, i.v., day 1; epirubicin 120 mg/m2, i.v., day 1; cyclophosphamide 600 mg/m2, i.v., day 1) plus G-CSF (300 microg/day, subcutaneous injection for 9 days, from day 4 post-FE120C) was used to mobilize PBSCs. After high-dose CTCb (cyclophosphamide 6,000 mg/m2, thiothepa 500 mg/m2, carboplatin 800 mg/m2, in 4 days), patients received PBSC infusion and daily C-CSF 300 microg subcutaneous injection. There were 19 and 16 patients enrolled into Group I and Group II, respectively. Ten of the Group II patients had achieved minimal residual disease (MRD) after induction chemotherapy. The median numbers of mobilized total CD34 + cells for Group I and Group II patients were 27.3 (9.2 to 114.1) x 10(6)/kg and 17.1 (5.9 to 69.1) x 10(6)/kg respectively. The median time to neutrophil recovery (ANC > or = 500/microL) was 8 and 9 days in Group I and II, respectively. The median time to platelet recovery (> or = 50,000/microL) was 10 and 15 days in Group I and II, respectively. No major treatment-related toxicities were noted. In Group I, 13 out of 19 patients (68.4%; 43-87%, 95% C.I.) remained recurrence-free with a median follow-up of 31 months (6 + to 55 + months). In Group II, 3 out of 10 patients (30%; 7-65%, 95% C.I.) remained progression-free at 33 +, 35 +, 39 + months from induction therapy. We suggest that the FE120C plus G-CSF is an effective and innovative regimen for PBSC mobilization in breast cancer patients, and high-dose CTCb therapy with PBSC support is a safe and well-tolerated treatment modality.

Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy, ultrasound and conventional mammography

Axillary lymph node status is important in the staging of breast carcinoma. To evaluate the accuracy of technetium-99m sestamibi breast scintigraphy in detecting metastatic axillary lymph nodes as compared with other accepted imaging modalities, we performed 99mTc-sestamibi breast scintigraphy, conventional mammography and ultrasound in 36 patients with primary untreated breast carcinoma. With histopathology as the gold standard, 99mTc-sestamibi breast scintigraphy was found to yield true-positive results in 7 of 11 cases (64%) of axillary lymph node metastases and true-negative results in 18 of 20 cases (90%); it has an accuracy of 81%, a positive predictive value of 77.8% and a negative predictive value of 81.8%.

Prognostic relevance of carcinoembryonic antigen and estrogen receptor status in breast cancer patients

BACKGROUND

Expression of carcinoembryonic antigen (CEA) has been reported in 10-95% of breast cancer. Its value as a predictor of disease progression is controversial.

METHODS

The expression of CEA in 202 Stages I and II breast carcinomas was assessed by immunohistochemistry, and the results were correlated with various histologic and clinical parameters to establish CEA's biologic relevance. The mean follow-up of the patients was 6.5 years. The monoclonal antibody used does not cross-react with other molecules in the CEA gene family.

RESULTS

One hundred, thirteen (56%) tumors expressed CEA in more than 15% of the cells. Expression of CEA was associated with positive estrogen receptor (ER) status (P = 0.003). Univariate Cox regression analysis showed that, whereas disease free survival (DFS) and overall survival (OS) were not associated significantly with CEA expression, tumor size, nuclear grade, ER status, lymph node metastases, and stage were. When ER status was stratified to CEA expression, patients who were ER negative and had CEA-negative tumors had a 3.9 times higher risk (P = 0.032) of death than did the patients with CEA-positive tumors. Cox regression analysis revealed that ER was the only parameter with significant interacting effect with CEA. Multivariate, stepwise Cox regression analysis showed that CEA expression, tumor size, and nuclear grade were the only significant independent predictors of DFS, and nuclear grade and lymph node metastasis the only significant predictors of OS in the ER-positive group. The only significant independent predictor of DFS and OS in the ER-negative group was CEA. When CEA expression was stratified to ER status, patients whose tumors lacked CEA and ER had threefold higher risk of disease relapse (P = 0.002) and a 5.3-fold higher risk of death (P = 0.0001) than those with ER-positive and CEA-negative tumors. Multivariate analysis showed that the association between CEA and ER was enhanced further after compensating for other parameters with independent predictive value.

CONCLUSIONS

The association between CEA and ER was the most important independent predictor of a subgroup of patients (CEA-negative, ER-positive) with the most favorable prognosis. The results imply that the association of several tumor markers may provide tumor profiles with superior predictive value than a single parameter.

Integration of risk factors to allow patient selection for adjuvant systemic therapy in lymph node-negative breast cancer patients

The selection of patients with axillary lymph node-negative breast cancer who should receive adjuvant therapy today is confused by an expanding arsenal of putative prognostic factors. The size of the primary tumor remains the dominant factor in sorting among this group of patients, with general agreement that tumors 1 cm or less should be spared adjuvant systemic therapy outside of a clinical trial. There are a few favorable histologic subgroups that may be added to this excluded group: ductal carcinoma in situ and pure tubular, papillary, and typical medullary tumors. For the larger tumor (generally > 2 cm in diameter, but always > 3 cm), there is little disagreement that adjuvant therapy is indicated. The host of additional prognostic factors are directed mainly toward the group of tumors that fall between these two categories. Nuclear grade, S-phase, and perhaps p53 mutations influence decisions for treatment by their elevation. Although the decision remains with the patient and the recommendation with the mature judgment of the clinician, the prognostic indicators available continue to multiply. That an indicator can retrospectively sort prognosis is of limited interest. It requires prospective validation in another patient population, reproducibility in other laboratories, and multivariate analysis among factors measured on the same population of patients to integrate a factor into clinical decision-making. It is only beginning to be accomplished. The next generation of factors being sought are those that predict for response or lack of response to specific therapies, rather than merely indicating natural history. Estrogen and progesterone receptors are the prototypes of this class of indicators.

3H-thymidine labeling index, hormone receptors, and ploidy in breast cancers from elderly patients

Breast cancers from 476 elderly patients, 70 years and older, operated on since 1972, were analyzed for proliferative activity, hormone receptors, and DNA content. Tumor proliferative activity, expressed as 3H-thymidine labeling index (3H-TdR LI), had a median value of 3.4%, which progressively increased from 1972 to 1990. Estrogen and progesterone receptors were present respectively in 83% and 61% of the cases; the positivity for estrogen receptors slightly increased with time. Aneuploid clones were detected in 74% of the cases, and this incidence was relatively stable during the time of observation. 3H-TdR LI, hormone receptors, and ploidy were generally unrelated to the local-regional extension of the disease in these elderly patients, in agreement with observations on cancer from younger patients. However, the absence of hormone receptors and the presence of aneuploidy were markedly indicative of fast cell proliferation. As in younger patients, these biologic findings in elderly patients could be considered as a complement to clinico-pathologic features in a 'risk-factor profile system' for treatment planning.

Cytosol protein content and prognosis in operable breast cancer. Correlations with steroid hormone receptors and other prognostic factors

Several biochemical parameters quantitated in tumor cytosols from malignant breast tumors have been evaluated as possible prognostic factors. Cytosol protein content has always been regarded as a reference parameter, to correct for cellularity and representativity of tumor samples. But recent studies have suggested an altered protein distribution in malignant tissues. The present study on 382 women with histologically proven breast cancer, Stage I and Stage II, therefore evaluates whether cytosol protein content by itself may add information as a prognostic factor in the clinical management of breast cancer. Cytosol protein content was found to be significantly correlated (p less than 0.001) to tumor size, and inversely correlated to progesterone receptor (PgR) content (p = 0.015) and age at operation (p = 0.021). Using the median value of protein (4.15 mg/ml) as a cut-off value, two groups could be constructed. The number of node-positive patients in the protein-poor group was significantly decreased (p = 0.018) compared to the protein-rich group, which also contained a significantly (p less than 0.001) lower number of patients with estrogen receptor (ER) positive tumors (i.e. ER greater than or equal to 10 pmol/g). An increased number of events was observed in the protein-rich group (p less than 0.001), with a great contribution to the number of deaths due to breast cancer. In a multivariate analysis of the likelihood to predict axillary nodal involvement, protein category was found to be a significant (p less than 0.031) independent predictive factor. As to relapse free survival (RFS), protein category did not reveal any prognostic power.(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvant systemic therapy of stage I and II breast cancer

The value of adjuvant systemic therapy has been clearly demonstrated in both node-positive and node-negative patients. However, there are many women with favorable prognoses whose breast cancer recurs. It has been possible only recently to identify subsets of patients who are at definite risk for recurrence. Advances both in selection and treatment of patients with early-stage breast cancer are being made as critical research questions are delineated and examined in prospective randomized trials.

Laminin receptors, collagenase IV and prognosis in node-negative breast cancers

In 187 node-negative breast cancers, the expression of laminin receptors and collagenase IV was directly related in 52% of cases, independently of pathological (tumor size and histology) and biological (estrogen receptors and proliferative activity) features. Moreover, the presence of laminin receptors and collagenase IV did not appear to influence tumor proliferative activity, evaluated as 3H-thymidine labelling index. In this case series, relapse-free survival and overall survival at 6 years were significantly affected by tumor size, hormone receptor status and proliferative activity. Conversely, high levels of laminin receptors and collagenase IV failed to influence relapse-free or overall survival, whereas they were strong indicators of local-regional diffusion of the disease.

Overall survival of breast cancer patients in relation to preclinically determined total serum cholesterol, body mass index, height and cigarette smoking: a population-based study

Mean overall 5-year survival related to preclinically determined total serum cholesterol, body mass index (BMI), height and cigarette smoking has been analysed among 242 incident cases of breast cancer aged 36-63 years that developed in a population of 24,329 Norwegian women during a mean follow-up of 12 years (range 11-14). The study factors were ascertained at least 1 year prior to diagnosis (mean = 8 years), and the cases have been followed up with respect to death for a mean time of approximately 5 years after diagnosis. Patients whose preclinical total serum cholesterol values were within the highest quartile (greater than or equal to 7.52 mmol/l, mean = 8.58 mmol/l) of the underlying population had a hazard ratio of dying of 2.0 (95% confidence limits, 1.1 and 3.7) compared to cases with cholesterol values in the lowest quartile (mean = 5.28 mmol/l), after adjustment for age at diagnosis, clinical stage, and body mass index. In relation to BMI (Quetelet's index: weight/height2) patients who were obese prior to diagnosis were at higher risk of dying than those who were lean. Compared to patients in the lowest quartile of BMI (mean Quetelet = 21), the hazard ratio was 2.1 (95% confidence limits, 1.2 and 3.8) for patients in the highest quartile (mean Quetelet = 30), after adjustment for age at diagnosis, clinical stage, and total serum cholesterol. For height and for cigarette smoking, no relation with survival was observed. A potential problem of this study might be insufficient information about other well known prognostic factors, but the results suggest that preclinical total serum cholesterol and BMI are positively associated with the risk of dying among women who develop breast cancer.

Cell kinetics and hormonal features in relation to pathological stage in breast cancer

Proliferative activity (expressed as 3H-thymidine labeling index, 3H-TdR LI) was evaluated on a series of 281 primary tumors recruited in two years in 6 different institutions from central Italy. 3H-TdR LI proved to be low in intraductal, or well and moderately differentiated, or hormone receptor positive tumors. Conversely, no relation was observed between 3H-TdR LI and menopause, tumor size, or lymph node involvement. An inverse relation was observed between 3H-TdR LI and hormone receptor content. Specific patterns of 3H-TdR LI value and ER content association were observed as a function of menopause, lymph nodal status, and degree of lymph nodal involvement.

Cytosol albumin content in operable breast cancer. Correlations to steroid hormone receptors, other prognostic factors and prognosis

Albumin content has been reported to be significantly different in cytosols from benign and malignant breast tumors, with a higher level in benign lesions. Low albumin content is suggested to be associated with a higher tendency to axillary nodal involvement in breast cancer patients. Albumin contributes greatly to the total amount of protein in tumor cytosol, and is easily measured. Albumin was measured in cytosols from 382 patients with breast cancer stage I and II, to evaluate correlations to other tumor variables and to investigate whether it may add information as a prognostic factor. The albumin content was expressed in percentages of total cytosol protein, with a median value of 18.5% for the study population. It was found to be significantly inversely correlated to estrogen receptor (ER) content. Cytosol protein content was inversely correlated to albumin. In addition to tumor size and axillary nodal involvement, albumin content was found to be an independent prognostic factor for relapse-free survival in an analysis of different prognostic variables in patients not given adjuvant endocrine treatment. Low albumin content (less than median) seems to predict effect of adjuvant tamoxifen treatment.