The Prognostic Significance of Proliferating Cell Nuclear Antigen in Patients With Lymph Node–Positive Breast Cancer

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Abstract
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) × 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 (≤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. Arch Surg. 1997;132:264-267