title: Proliferation rate, hormone receptor status and p53 expression in skeletal metastasis of breast carcinoma.
abstract: Immunohistochemistry was used to analyze ER, PgR, MIB, and p53 of primary breast carcinomas and their skeletal metastases in 43 patients operated on for 47 pathological fractures. Femoral lesions predominated (24), followed by metastases to the spine (13). The median survival time from diagnosis of the primary breast carcinoma was 5.5 (0.5-20) years and from pathological fracture 5 (0-76) months. No clinical characteristics of the primary tumor were prognostic for survival after pathological fracture. Thirty of 47 tissue specimens from skeletal metastases were ER positive and 17 negative. Fourteen of 47 tissue specimens from skeletal metastasis were positive for PgR. Forty-five of the 47 metastases could be evaluated for p53 positivity and 43 tumors showed nuclear staining of varying intensity. In a majority of the cases there was a good correlation between ER, PgR and p53 in the primary tumors and their corresponding metastases. p53 negative primary tumors were associated with longer survival from diagnosis, but also found after pathological fracture. No correlation was observed between ER index or MIB-1 in the skeletal metastases and postoperative survival. PgR positivity in skeletal metastases was associated with longer survival after pathological fracture. This study shows that biological markers such as PgR and p53 provide prognostic information after pathological fracture. The findings should be regarded with caution as there are many confounding factors such as prior chemo- and radiotherapy. Nevertheless, the approach, to gather prognostic data at the time of pathological fracture, warrants further study as expected survival time is paramount in the choice of surgical treatment.
authors.affiliation: Correspondence to: R. Wedin, Oncology Service, Department of Orthopedics, Karolinska Hospital, S-171 76 Stockholm, Sweden. rikard.wedin@kus.se
authors.forename: Rikard
authors.initials: R
authors.lastname: Wedin
authors.forename: Lambert
authors.initials: L
authors.lastname: Skoog
authors.forename: Henrik C F
authors.initials: HC
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary*; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D002455:Cell Division; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D008875:Middle Aged; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*
chemical_list: D019394:Ki-67 Antigen; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D016159:Tumor Suppressor Protein p53