ANGIOGENIN EXPRESSION AND PROGNOSIS IN PRIMARY BREAST-CARCINOMA

Angiogenin is a protein originally isolated as an inducer of new blood vessel growth, and it has been reported to be an effective substrate for tumor cell adhesion. To understand the role of angiogenin in cance r progression, we evaluated the expression of angiogenin in 459 cases with primary breast carcinoma and in 40 benign breast specimens using an immunoassay, Higher angiogenin concentrations were observed in carc inomas in comparison with fibrocystic disease (mean, 17.3 versus 10.9 ng/mg; P = 0.008), but not with fibroadenomas,We selected 5 ng/mg cyto sol protein of angiogenin as the normal cutoff for primary breast carc inoma. Eighty-eight percent of carcinomas expressed elevated angiogeni n levels and 12% had low levels. We observed an association between el evated levels of angiogenin and low/ moderate histological grade (P = 0.001) and small tumor size (P = 0.026), but not with age, menopausal status, lymph node status, stage of disease, or hormonal receptor stat us, With a median follow-up of 31 months, breast cancer patients with elevated angiogenin Levels had significantly longer disease-free survi val (DFS) than patients with low angiogenin (log-rank, P = 0.003), Thi s effect was equally observed in node-negative and node-positive cases . In a multivariate analysis of DFS, only angiogenin, tumor size, and histological grade showed statistical significance. A multivariate ana lysis of overall survival showed that angiogenin and tumor size were t he only significant variables, Serum samples from the breast cancer pa tients at the time of surgery were available in 194 cases. We evaluate d the levels of circulating angiogenin using the same immunoassay as i n tumor tissue. Serum angiogenin levels were higher in cancer patients than in 40 healthy controls (mean, 401.2 versus 206.0 ng/ml; P < 0.00 01), In breast cancer patients, we observed no correlation between the serum concentrations and the tissue levels of angiogenin (r = 0.115; P = 0.110), In addition, serum levels of angiogenin did not have a pro gnostic impact on the DFS of breast cancer patients (log-rank, P = 0.5 81). Our results indicate that elevated levels of tissue angiogenin, b ut not of circulating angiogenin, are a favorable prognostic factor in primary breast carcinoma, which is consistent with a role of angiogen in as a cancer cell substrate.