A 27 KDA HEAT-SHOCK PROTEIN THAT HAS ANOMALOUS PROGNOSTIC POWERS IN EARLY AND ADVANCED BREAST-CANCER

This paper describes a prospective immunohistochemical analysis of 27 kDa heat shock protein (HSP27) in 361 patients with primary breast can cer in relation to disease-free survival (DFS) and survival from first relapse (SR). Oestradiol (ER) and progesterone (PR) receptors were al so quantitated and related to the HSP27 data. While ER positively pred icted a good outcome for both DFS and SR, HSP27 positivity predicted a prolonged SR but short DFS. The association between HSP27 and DFS onl y attained statistical significance in node-negative patients. Subgrou p analysis reinforced the complementary relationship of HSP27 and ER f or SR and opposing influences for DFS. In both node-negative and node- positive women, ER+ HSP27- patients had a longer DFS than ER- HSP27+ c ounterparts. There was no relationship between HSP27 and overall survi val. HSP27 staining was highly correlated with ER but not PR, patient age, tumour size or menstrual status. There was a marginal correlation (P = 0.04) with histological grade with well-differentiated tumours h aving the highest HSP27. Cox multivariate regression analysis of the c ontribution of HSP27 in the presence of data on ER, PR, stage, nodal s tatus and histological grade indicated that HSP27 was not of independe nt prognostic importance for DFS or overall survival and was only of b orderline significance for OS (P < 0.07). However, in the absence of E R and PR data, HSP27 staining is an effective way of getting the same prognostic information. HSP27 staining appears to correlate with diffe rent biological features in early and advanced breast, high HSP27 bein g linked with short DFS in node-negative patients but with prolonged s urvival from first recurrence.