title: Prolactin as a local growth promoter in patients with breast cancer: GCRI experience.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic value of pre-operative prolactin (PRL) in conjunction with established prognosticators, and the risk of disease relapse in patients with early and advanced breast cancer. To confirm the hypothesis that PRL is produced by breast tumours molecular analysis of PRL, using immunohistochemistry, mRNA by RT-PCR and direct sequencing, was performed. Furthermore, presence of prolactin receptors (PRLR) was evaluated by immunohistochemical localization in these patients.
  
  
  METHODS
  In 111 breast cancer patients, pre-operative PRL was determined by an immunoradiometric assay (IRMA) method. Immunohistochemical localization of PRL (IHL-PRL) and PRLR was performed on formalin-fixed, paraffin-embedded tissue sections. Expression of PRL mRNA was carried out by reverse transcriptase polymerase chain reaction (RT-PCR). RT-PCR PRL amplimer was sequenced and compared with human pituitary PRL amplimer.
  
  
  RESULTS
  Fifty-eight per cent (64/111) of the patients had hyperprolactinaemia (PRL520.0 ng/ml). With increasing tumour size, a higher incidence of hyperprolactinaemia was noted which was statistically significant (r=0.34, P=0.0001). In stage III patients, and in node positive patients, the incidence of hyperprolactinaemia was significantly higher compared to their respective counterparts (stage II vs stage III, r=0.37, P=0.00006; node negative vs node positive, r=0.30, P=0.001). Hyperprolactinaemic patients had a significantly higher risk of developing recurrent/metastatic disease and a higher mortality risk as compared to patients with PRL <20.0 ng/ml. The multivariate survival analysis indicated that apart from disease stage, prognosis of patients with pre-operative hyperprolactinaemia was poorer than that of patients with PRL <20.0 ng/ml. Seventy-eight per cent (87/111) of the tumours showed positive immunoreactivity with PRL antibody indicating that PRL, or a similar molecule, is produced ectopically by breast tumours. PRL mRNA expression using RT-PCR confirmed the de novo synthesis of PRL. PRL mRNA expression was seen in 52% (33/63) of tumours. Sequence analysis of the 234 bp PRL amplimer revealed that the sequence was homologous to the sequence of exon 5 of human pituitary PRL mRNA. Furthermore, PRLR were present in 80% of tumours detected by immunohistochemical localization. A significant positive correlation was noted between IHL-PRL and PRLR (r=0.26, P=0.006).
  
  
  CONCLUSIONS
  This multifaceted study of PRL suggests that breast cancer cells produce PRL and that this ectopically produced PRL may act as a major local growth promoter via autocrine and paracrine mechanisms. It may provide new insights into endocrine treatment of breast cancer.
authors.affiliation: The Gujarat Cancer and Research Institute, NCH Compound, Asarwa, Ahmedabad, 380 016, India.
authors.forename: J M
authors.initials: JM
authors.lastname: Bhatavdekar
authors.forename: D D
authors.initials: DD
authors.lastname: Patel
authors.forename: N G
authors.initials: NG
authors.lastname: Shah
authors.forename: H H
authors.initials: HH
authors.lastname: Vora
authors.forename: T P
authors.initials: TP
authors.lastname: Suthar
authors.forename: N
authors.initials: N
authors.lastname: Ghosh
authors.forename: P R
authors.initials: PR
authors.lastname: Chikhlikar
authors.forename: T I
authors.initials: TI
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000096:biosynthesis* / Q000097:blood / Q000235:genetics; D001943:Breast Neoplasms / Q000097:blood / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006133:Growth Substances / Q000096:biosynthesis* / Q000097:blood / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011388:Prolactin / Q000096:biosynthesis* / Q000097:blood / Q000235:genetics; D012333:RNA, Messenger / Q000096:biosynthesis / Q000235:genetics; D011981:Receptors, Prolactin / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D006133:Growth Substances; D012333:RNA, Messenger; D011981:Receptors, Prolactin; D011388:Prolactin