Predictors of distant metastasis at presentation in breast cancer: a studyalso evaluating associations among common biological indicators

Background. To investigate the correlation among some of the commonly used clinical, pathological factors and newer biological indicators, and to iden tify the independent predictors of distant metastasis at presentation in pa tients with breast cancer. Methods. The pathological specimens from 73 patients with breast cancer wer e retrospectively evaluated by immunohistochemistry. Data on 13 biological indicators; ER, PR, P53, c-erbB-2, PCNA, CEA, Ki-67, Vimentin, Ulex, Nm23, Cathepsin D, Factor VIII, PS2 together with clinical and pathological facto rs were collected. Results. A number of highly significant correlations were found among the b iological indicators studied. By logistic regression analysis, the predicto rs of distant metastasis at presentation in univariate tests were tumor dia meter, number of lymph nodes involved, P53, c-erbB-2 and grade. In multivar iate analysis, tumor diameter (P = 0.042, HR: 1.88(1.02-3.44)), c-erbB-2 ex pression (P = 0.035, HR: 18.20 (1.23-268.66)) and grade (P = 0.010, HR: 8.0 5(1.66-39.00)) retained their significance. Conclusion. Our findings show that inactivation of suppressor genes, expres sion of oncogenes, loss of differentiation, augmentation of proliferative a ctivity, metastatic potential, angiogenesis and hormone receptor status are all interrelated facets of breast cancer pathogenesis. Patients with tumor s overexpressing c-erbB-2 or with bigger or higher-grade tumors probably ne ed to be more carefully evaluated for the presence of distant metastasis, t hus be better staged, at presentation. This may be a new reason to test c-e rbB-2 routinely in all patients with breast cancer in addition to its well- known prognostic and predictive uses.