title: Cyclin A and E2F1 overexpression correlate with reduced disease-free survival in node-negative breast cancer patients.
abstract: BACKGROUND
  Available prognostic factors do not accurately identify node-negative breast cancer patients at high risk of disease recurrence and progression.
  
  
  METHODS
  Cyclin A and E2F1 expression levels were evaluated in 75 consecutive node-negative breast cancer patients with a median follow-up of 10 years. Both parameters were tested for correlation with all the available clinicopathological parameters and with the clinical evolution of the disease.
  
  
  RESULTS
  Cyclin A was overexprNed in 45.3% of patients and significantly related to large tumor size, high Ki67 and high E2F1 expression levels. No relationship was observed between cyclin A and tumor estrogen receptor (ER) status, grading or patient age. Seventeen patients relapsed within 5 years from diagnosis. Twelve (71%) of them showed cyclin A overexpression in comparison with 22 (38%) out of the 58 who did not relapse (p = 0.02). Disease-free survival (DFS) was significantly shorter in patients with cyclin A-overexpressing tumors compared to non-overexpressing ones (p = 0.01). DFS was also significantly longer in low vs. high Ki67 expression (p = 0.003) and in low vs. high E2F1 expression (p = 0.02). On multivariate analysis, the simultaneous high expression of all three parameters (cyclin A, Ki67 and E2Fl) was a strong independent prognostic factor for shorter DFS (HR 13.4).
  
  
  CONCLUSIONS
  These findings suggest that assessment of cyclin A and/or E2F1 expression levels, associated with Ki67, might be useful for a better prognostic evaluation of node-negative breast cancer patients and support the need for further studies to evaluate their suitability for use in the routine clinical management of these patients.
authors.affiliation: Medical Oncology, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Editta
authors.initials: E
authors.lastname: Baldini
authors.forename: Andrea
authors.initials: A
authors.lastname: Camerini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sgambato
authors.forename: Tiziana
authors.initials: T
authors.lastname: Prochilo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Capodanno
authors.forename: Francesco
authors.initials: F
authors.lastname: Pasqualetti
authors.forename: Cinzia
authors.initials: C
authors.lastname: Orlandini
authors.forename: Letizia
authors.initials: L
authors.lastname: Resta
authors.forename: Generoso
authors.initials: G
authors.lastname: Bevilacqua
authors.forename: Paola
authors.initials: P
authors.lastname: Collecchi
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism*; D019925:Cyclin A / Q000378:metabolism*; D018572:Disease-Free Survival; D050687:E2F1 Transcription Factor / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged
chemical_list: D019925:Cyclin A; D050687:E2F1 Transcription Factor