PROGNOSTIC VALUE OF P21(WAF1) AND P53 EXPRESSION IN BREAST-CARCINOMA - AN IMMUNOHISTOCHEMICAL STUDY IN 261 PATIENTS WITH LONG-TERM FOLLOW-UP

p21 protein (p21) inhibitor of cyclin-dependent kinases is a critical downstream effector in the p53-specific pathway of growth control and can also be induced by p53-independent pathways in relation to termina l differentiation. We investigated p21 immunoreactivity in 261 breast carcinomas (141 node negative and 120 node positive) with long-term fo llow-up (median, 73 months; range, 37-119), p21 was seen in 214 (82%) infiltrating tumors, staining was nuclear and heterogeneous, and the p 21 labeling index ranged from 0 to 90%, Sixty-eight (32%) patients sho wed p21 overexpression (> 10% of reactive tumor cells), p21 overexpres sion was associated with large tumor size, positive nodal status, high histological grade, and high mitotic count and was related to short d isease-free survival (DFS) in the whole series of patients (P = 0.04), in the node-negative subgroup (P = 0.004), and in the group of patien ts who did not undergo systemic adjuvant therapy (P = 0.003), In patie nts treated with systemic adjuvant therapy, bivariate analysis of the combined p21 and p53 phenotypes showed that p21+/p53+ tumors were asso ciated with long DFS and overall survival (OS), whereas p21-/p53+ tumo rs had the worst prognosis, In treated patients, multivariate analysis showed that the p21-/53+ phenotype was independently associated with short DFS and OS, Our present data support the hypothesis that p21/p53 heterogeneous expression may be of clinical relevance for the therape utic response to chemotherapy/hormonotherapy, The p21-/p53+ phenotype could correspond to a situation where p53 overexpression really reflec ts complete abrogation of p53 function, These cases with disrupted p53 function should have impaired the G(1) checkpoint and may not be able to activate the apoptotic cascade in response to DNA-damaging drugs.