© The Author 2006. Published by Oxford University Press.
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p27Kip1 and Cyclin E Expression and Breast Cancer Survival After Treatment With Adjuvant Chemotherapy
Affiliations of authors: Divisions of Human Biology and Public Health Sciences (PLP, MGL, XPY, ED) and Basic Sciences (JMR), Fred Hutchinson Cancer, Research Center, Seattle, WA; Departments of Pathology (PLP),Biostatistics (WEB), and Oncology (RBL), University of Washington, Seattle, WA; Cancer Rsearch and Biostatistics, Southwest Oncology Group Statistical Center, Seattle, WA (WEB); Department of Pathology, University of Texas Health Science Center, San Antonio, TX (ITY); Department of Medicine and Pathology, Indiana University, Indianapolis, IN (GWS); Department of Hematology and Oncology, Ohio State University, Columbus, OH (CLS); Department of Oncology, Mayo Clinic, Rochester, MN (JNI); Department of Medicine, University of California, Los Angeles, CA (CMH); Department of Hematology and Oncology, Loyola University, Chicago, IL (KSA); Department of Medicine, University of Michigan, Ann Arbor, MI (DFH)
Correspondence to: Peggy L. Porter, MD, Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, Seattle, WA 98109 (e-mail: pporter{at}fhcrc.org).
Background: Abnormal expression of the cell cycle regulatory proteins p27Kip1 (p27) and cyclin E may be associated with breast cancer survival and relapse. We studied these markers in a clinical trial setting with patients with breast cancer treated by a uniform drug regimen so that treatment was not associated with variability in outcome. Methods: We used tissue microarrays to evaluate the expression of p27 and cyclin E proteins by immunohistochemistry in tumor tissue from 2123 (68%) of 3122 patients with moderate-risk primary breast cancer who were enrolled in Southwest Oncology Group–Intergroup Trial S9313, in which patients were assigned to receive doxorubicin and cyclophosphamide administered concurrently (n = 1595) or sequentially (n = 1527). Disease-free and overall survival were equivalent in the two arms. Expression of the proteins was rated on a scale of 1–7, and the median value was used as the cut point. Log-rank tests and Cox regression analyses were used to assess associations with survival. Overall survival was defined as time to death from all causes; disease-free survival was defined as time to recurrence or death. All P values were from two-sided statistical tests. Results: Lower p27 expression was associated with worse overall survival (unadjusted hazard ratio [HR] = 1.50, 95% confidence interval [CI] = 1.21 to 1.86) and disease-free survival (unadjusted HR = 1.31, 95% CI = 1.10 to 1.57) than higher p27 expression. Among hormone receptor–positive patients, lower p27 expression was associated with worse overall survival (HR = 1.42, 95% CI = 1.05 to 1.94) and worse disease-free survival (HR = 1.27, 95% CI = 0.99 to 1.63) than higher p27 expression after adjustment for treatment, menopausal status, tumor size, and number of positive lymph nodes. Among these patients, 5-year overall survival associated with higher p27 expression (0.91, 95% CI = 0.89 to 0.93) was similar to that associated with lower p27 expression (0.85, 95% CI = 0.82 to 0.87). No association between p27 expression and survival was found in hormone receptor–negative patients. Cyclin E expression was not statistically significantly associated with overall survival (HR = 1.12, 95% CI = 0.91 to 1.38) or disease-free survival (HR = 1.09, 95% CI = 0.92 to 1.29). Conclusions: Low p27 expression appears to be associated with poor prognosis, especially among patients with steroid receptor–positive tumors.
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- Re: p27Kip1 and Cyclin E Expression and Breast Cancer Survival After Treatment With Adjuvant Chemotherapy
- Paul N. Span, Pieter H. de Mulder, and Fred C. G. J. Sweep
J Natl Cancer Inst 2007 99: 738.[Extract] [Full Text] [PDF]
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