The prognostic significance of proliferating cell nuclear antigen in patients with lymph node-positive breast cancer
S. M. Sheen-Chen, H. L. Eng, F. F. Chou and W. J. Chen
Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
OBJECTIVE: To evaluate the prognostic significance of proliferating cell
nuclear antigen (PCNA) in patients with lymph node-positive primary breast
cancer. DESIGN: A retrospective study. SETTING: A tertiary care hospital.
STUDY PARTICIPANTS: A consecutive series of 123 patients with lymph
node-positive primary breast cancer. INTERVENTION: The PCNA-labeling index
[(PCNA-positive cells/1000 cells) x 100] was quantified in
paraffin-embedded tissue specimens from 123 patients with lymph
node-positive primary breast cancer by immunohistochemical staining. Other
important clinicopathological variables, including estrogen receptor
status, histological grade, lymph node status, primary tumor status, ploidy
pattern, S-phase fraction, and TNM staging, were also identified and
evaluated. MAIN OUTCOME MEASURES: The influence of the PCNA-labeling index
on the disease-free survival rate and overall survival rate. RESULTS: The
PCNA-labeling index of the tissue specimens tested from 123 patients ranged
from 11% to 82%. The PCNA-labeling index was closely related to primary
tumor status, histological grade, TNM staging, and S-phase fraction.
Between patients with a high PCNA-labeling index (> 35%) and those with
a low PCNA-labeling index (< or = 35%), there were significant (P <
.01) differences in both 5-year disease-free survival rates (2% vs 85%) and
5-year overall survival rates (2% vs 92%). When the PCNA-labeling index and
all the clinicopathologic variables were entered into a multivariate
analysis for either disease-free survival or overall survival by the Cox
proportional hazards model, the PCNA-labeling index emerged as an
independent prognostic factor. CONCLUSION: Based on our results, the
PCNA-labeling index potentially is a useful prognostic factor for lymph
node-positive primary breast cancer.
