PREGNANCY-ASSOCIATED PLASMA PROTEIN-A AND EXTENSIVE NECROSIS - CLINICALLY SIGNIFICANT PREDICTORS OF EARLY RECURRENCE IN STAGE-I ESTROGEN RECEPTOR-NEGATIVE BREAST-CARCINOMA

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  • 1 January 1985
    • journal article
    • research article
    • Vol. 53  (1) , 101-107
Abstract
Despite advances in the detection of early breast cancer, 25-35% of patients with stage I disease die from metastatic breast carcinoma. To identify those patients at risk for early recurrence, the 33 clinical and pathologic features as well as immunoperoxidase-staining characteristics for carcinoembryonic antigen, human chorionic gonadotropin, pregnancy specific .beta.-1 glycoprotein and pregnancy-associated plasma protein A (PAPP-A) were renewed in 40 patients with stage 1 estrogen receptor-negative breast carcinoma. Of the 40 patients 16 (40%) developed tumor recurrence within 2 yr. Pairwise correlations between recurrence and clinicopathologic features, including tumor marker immunostaining, revealed significant correlations between extensive necrosis, nuclear atypia, mitoses and PAPP-A staining. In multivariant linear discriminant analysis, only PAPP-A staining and extensive necrosis entered as significant independent predictors. In the recurrent group, 9 of 16 (56%) were PAPP-A positive compared with 1 of 24 (4%) in the nonrecurrent group (P < 0.001), whereas 9 of 16 (56%) contained extensive necrosis compared with 3 of 24 (11%) in the nonrecurrent group (P < 0.005). When the independent risk factor of PAPP-A positivity and extensive necrosis were combined, 13 of 16 (81%) of the recurrent tumors were either PAPP-A positive or extensively necrotic compared with 4 of 24 (16%) of the nonrecurrent group. Thus, positive immunostaining for PAPP-A and the presence of extensive necrosis are clinically significant independent predictors of early recurrence in patients with stage I, estrogen receptor-negative breast carcinoma. These risk factors for early recurrence may be helpful in prospectively selecting patients most eligible to receive adjuvant chemotherapy.