title: Predictors of distant metastasis at presentation in breast cancer: a study also evaluating associations among common biological indicators.
abstract: BACKGROUND
  To investigate the correlation among some of the commonly used clinical, pathological factors and newer biological indicators, and to identify the independent predictors of distant metastasis at presentation in patients with breast cancer.
  
  
  METHODS
  The pathological specimens from 73 patients with breast cancer were 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 factors were collected.
  
  
  RESULTS
  A number of highly significant correlations were found among the biological indicators studied. By logistic regression analysis, the predictors of distant metastasis at presentation in univariate tests were tumor diameter, number of lymph nodes involved, P53, c-erbB-2 and grade. In multivariate analysis, tumor diameter (P = 0.042, HR: 1.88(1.02-3.44)), c-erbB-2 expression (P=0.035, HR: 18.20 (1.23-268.66)) and grade (P=0.010, HR: 8.05(1.66-39.00)) retained their significance.
  
  
  CONCLUSIONS
  Our findings show that inactivation of suppressor genes, expression of oncogenes, loss of differentiation, augmentation of proliferative activity, metastatic potential, angiogenesis and hormone receptor status are all interrelated facets of breast cancer pathogenesis. Patients with tumors overexpressing c-erbB-2 or with bigger or higher-grade tumors probably need to be more carefully evaluated for the presence of distant metastasis, thus be better staged, at presentation. This may be a new reason to test c-erbB-2 routinely in all patients with breast cancer in addition to its well-known prognostic and predictive uses.
authors.affiliation: Department of Internal medicine, Akdeniz University Medical Faculty, Antalya, Turkey. hbozcuk@antnet.net.net.tr
authors.forename: H
authors.initials: H
authors.lastname: Bozcuk
authors.forename: G
authors.initials: G
authors.lastname: Uslu
authors.forename: E
authors.initials: E
authors.lastname: Peştereli
authors.forename: M
authors.initials: M
authors.lastname: Samur
authors.forename: M
authors.initials: M
authors.lastname: Ozdoğan
authors.forename: S
authors.initials: S
authors.lastname: Karaveli
authors.forename: F
authors.initials: F
authors.lastname: Sargin
authors.forename: B
authors.initials: B
authors.lastname: Savaş
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000235:genetics / Q000556:secondary*; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D018734:Genes, erbB-2; D006801:Humans; D007150:Immunohistochemistry; D008499:Medical Records; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor