Metastatic potential in node-negatve breast carcinoma : role of nm23 and angiogenesis

الملخص EN

Background : In node-negative breast carcinoma (NNBC), identification of patients who are at high risk of tumor recurrence and requiring adjuvant chemotherapy can’t be identified by current clinicopathologic criteria and requires the development of additional prognostic parameters.

METHODS.

nm23, microvessel count (MVC) and estrogen receptor (ER) were detected immunohistochemical-ly in tissue section of 43 NNBC.

The patients were followed up for 5 years for evidence of tumor relapse.

Post-operative radiotherapy was given to 24 patients.

Out of the irradiated group 15 patients received chemotherapy and 3 patients received chemotherapy and hormonal therapy.

Results : out of 43 NNBC, high nm23 was detected in 44.2 % of cases and low nm23 was detected in 55.8 %.

A significant correlation was observed between nm23 level and tumor size as well as ER status of the patients.

High MVC was encountered in 37.2 % of cases and low MVC was detected in 62.8 %.

A significant correlation was observed between MVC and tumor size.

A significant inverse correlation between nm23 level and MVC was observed.

Follow-up of the patients for 5 years revealed relapse in 35.9 %.

The 5-year disease free survival (DFS) was 64.1 %...

nm23 level correlated significantly with DFS (p=0.008).

The 5-year DFS was 84.2 % for tumors with high nm23 level compared to 45 % for tumors with low nm23 level.

MVC level showed a high significant correlation with DFS (p < 0.001).

The 5-year DFS was 87.5 % for tumors with low MVC compared to 26.7 % for tumors with high MVC.

Multivariate analysis proved that only MVC appeared to be independent prognostic variable for DFS (p = 0.04).

Using the combination of nm23 level and MVC, we could identify a high risk group of patients with both low nm23 and high MVC, and a low risk group of patients with both high nm23 and low MVC.

The 5-year disease free survival was 25 % and 93.7 % respectively.

The difference was statistically significant (p < 0.001).

In the high risk group of patients both radiotherapy and chemotherapy correlated significantly with relapse rate (p = 0.02).

Conclusions : both nm23 and MVC appear to contribute valuable additional prognostic information in NNBC.

MVC proved to be the most important tumor factor predicting outcome.

Using both nm23 and MVC together could be a guide for therapy, as we could identify a group of patients who are at high risk of developing recurrence and who may benefit greatly from adjuvant treatment.