Prognostic value of estrogen receptor status can be improved by combined evaluation of p53, Bc12 and PgR expression: An immunohistochemical study on breast carcinoma with long-term follow-up

Steroid receptor analysis is the only widely accepted prognostic/predictive marker in breast cancer (BC) treatment. In the present study we evaluated the prognostic role of ER/PgR with p53 and Bcl2, in a series of 277 BC (153 pN1/2, 122 pNO, 2 pNx) with a long-term follow-up (67 months for DFS, 75 m onths for OS). Our results, besides confirming the usefulness of ER immunoh istochemical expression as a prognostic marker, showed that PgR expression alone had a borderline/not significant prognostic value in the whole series (p=0.08 for DFS and p=0.09 for OS), while showed to be prognostic in N+ ca ses (p=0.02 for DFS and p=0.03 for OS). PgR prognostic value, however, was not independent at the multivariate analysis. By combining ER with PgR, p53 and Bcl2, we showed that ER/p53 and ER/Bcl2 phenotypes had a better discri minant role than ER/PgR phenotype. The ER+/p53(+) phenotype was at higher r isk of relapse/death as compared with ER+/p53(-) phenotype. Conversely ER-/ p53(+) phenotype showed the most unfavourable prognosis. Similar results co uld be observed concerning ER/Bcl2 phenotypes. Our study showed that the co mbined evaluation of ER/PgR weakly enhanced the prognostic/predictive power of ER status alone. On the contrary, the combined evaluation of ER/p53 and ER/Bcl2, improved this prognostic/predictive capability and allowed the se paration of ER positive and ER negative cases into subgroups with different prognosis.