乳腺伴大汗腺分化的癌临床病理特征及预后分析

目的：探讨乳腺伴大汗腺分化的癌临床病理特点及影响其预后的因素。方法收集乳腺伴大汗腺分化的癌标本70例和同期诊断为非特殊型浸润性癌283例患者的临床病理资料,比较两组预后差异,并对患者年龄、肿瘤大小、淋巴结转移、组织学分级、分期、免疫组化等因素与预后的关系进行统计学分析。结果乳腺伴大汗腺分化的癌平均发病年龄(56．17±12．41岁)比非特殊型浸润性癌(52.77±11．07岁)高(P=0．039);与非特殊型浸润性癌相比,乳腺伴大汗腺分化的癌具有更低的腋窝淋巴结转移率,较低的ER、PR阳性率(P<0．05);乳腺伴大汗腺分化的癌患者与非特殊型浸润性癌患者相比,5年总生存率(P=0．221)和无病生存率(P=0．378)差异无统计学意义;单因素生存分析显示肿瘤大小、淋巴结转移、病理学分期、淋巴结外软组织浸润与乳腺伴大汗腺分化的癌患者预后有关(P<0．05),Cox多因素分析结果显示,淋巴结转移与乳腺伴大汗腺分化的癌患者不良预后有关(P<0．05)。结论乳腺伴大汗腺分化的癌与浸润性癌临床病理特征不同,但预后无统计学意义。淋巴结转移可作为乳腺伴大汗腺分化的癌患者预后不良的指标,早诊断、早治疗是改善其预后的关键。     

乳腺癌中INHBA表达及与临床预后的关系

目的检测INHBA(inhibin-βA)在乳腺癌及癌旁乳腺组织中的表达,探讨其与乳腺癌临床病理特征的关系及对乳腺癌患者预后的意义。方法应用免疫组化法检测85例乳腺浸润性导管癌及35例癌旁乳腺组织中INHBA的表达。结果INHBA在乳腺癌和癌旁组织中的表达差异有统计学意义(P0.05)。INHBA高表达和肿瘤较低的分化程度、淋巴结转移及较高的Ki-67增殖指数具有相关性(P0.05)。INHBA高表达乳腺癌患者的生存期明显短于低表达组(P0.05)。多因素Cox比例风险回归模型分析显示,INHBA表达可以作为判断乳腺癌患者的独立危险因素(P0.05)。结论INHBA表达与肿瘤分化程度、淋巴结转移及Ki-67增殖指数密切相关,可能参与乳腺癌的发生发展,可以作为乳腺癌患者预后的判断指标。     

乳腺癌淋巴结转移病例分析及研究

目的 分析和探讨乳腺癌患者病案资料及乳腺癌腋窝淋巴结转移情况，为医学科研项目提供真实数据。方法 对337例病理证实为乳腺癌病例进行统计分析。结果 乳腺癌患者的年龄跨度大，从二十几岁到九十几岁都有发生，主要发生于外上象限，约占60％。其中有95例有转移，转移途径以腋窝淋巴结为主要途径，结论 仅仅将腋窝淋巴结有无转移作为乳腺癌临床分期的重要指标之一也有其局限性。用前哨淋巴结来确定乳腺癌转移更为准确。     

淋巴结转移密度与乳腺浸润性导管癌预后的关系

目的探讨淋巴结转移密度与手术治疗乳腺浸润性导管癌患者预后的关系。方法回顾性分析113例乳腺浸润性导管癌的临床资料,按淋巴结转移密度分为ND40组、ND=0组和ND≤40组,采用Kaplan-Meier法和Cox比例风险模型,比较临床病理特征及淋巴结转移密度评价手术治疗乳腺浸润性导管癌患者5年无瘤生存率和总生存率的价值。结果 ND40组、ND=0组和ND≤40组5年无瘤生存率及总生存率,差异有统计学意义(P均0.05)。在Ⅲ期乳腺癌患者中,淋巴结转移密度提供良好的分层意义,ND40组Ⅲ期乳腺癌与Ⅳ期乳腺癌预后无差异(P=0.453)。单因素分析显示,脉管癌栓、淋巴结转移密度、TNM分期、雌、孕激素受体状态及p N分期均与患者的5年无瘤生存率和总生存率有关(P均0.05)。多因素分析显示,组织学分级及淋巴结转移密度是影响患者5年无瘤生存率的独立因素(P均0.05);淋巴结转移密度是影响患者5年总生存率的独立因素(P0.05)。结论淋巴结转移密度是手术治疗乳腺浸润性导管癌患者预后的独立因素,提示其可作为乳腺癌预后的参考标准,ND40组提示预后不良。     

非小细胞肺癌患者血清PCNA和癌组织NapsinA表达及与病理类型的关系

目的 研究分析非小细胞肺癌(NSCLC)患者血清细胞增殖抗原(PCNA)及癌组织NapsinA表达与患者病理类型的关系.方法 选取2016年2月至2017年2月我院收治的NSCLC患者100例为观察组,另取同期健康体检者50例为对照组.采用酶联免疫吸附法分别检测两组人员的血清PCNA水平,并分析PCNA与NSCLC患者临床病理特征的关系.采用免疫组化SP方法检测观察组癌组织以及癌旁组织的NapsinA表达情况,分析与患者临床病理特征的关系.结果 观察组患者的血清PCNA水平为(444.2 ±26.7) pg/mL,显著高于正常对照组的(290.5±16.2) pg/mL.癌组织NapsinA表达阳性率为80.00％ (80/100),显著低于癌旁正常组织的100.00％ (100/100).NSCLC分化程度为低中分化、TNM分期为Ⅲ～Ⅳ期以及有淋巴结转移患者的血清血清PCNA水平分别为(469.5±27.3) pg/mL、(472.5±26.8)pg/mL、(477.1±26.2) pg/mL,均显著高于高分化、TNM分期为Ⅰ～Ⅱ期以及无淋巴结转移患者.NSCLC病理类型为腺癌、高中分化、TNM分期为Ⅰ～Ⅱ期以及无淋巴结转移患者的NapsinA表达阳性率分别为100.00％ (72/72)、100.00％ (46/46)、95.24％(40/42)、92.31％ (48/52),均显著高于鳞癌与大细胞癌、分化程度为低中分化、TNM分期为Ⅲ～Ⅳ期、有淋巴结转移患者.以上对比均P ＜0.05差异有统计学意义.结论 NSCLC患者血清PCNA水平与病理类型无相关性,而癌组织NapsinA在腺癌中的表达显著高于鳞癌以及大细胞癌,上述两指标可作为判断患者分化程度、TNM分期及淋巴结转移的参考指标.而癌旁组织NapsinA阳性率对区分患者病情程度不具备参考价值     

生长抑制蛋白家族成员5(ING5)在人乳腺癌细胞的核质转运与不良临床病理特征的相关性分析

目的探究生长抑制蛋白家族成员5(ING5)在人乳腺癌细胞的核质转运及其ING5在细胞核和胞质高表达与不良临床病理特征的相关性。方法收集乳腺癌260例、淋巴结转移性乳腺肿瘤55例、乳腺纤维腺瘤61例、乳腺腺瘤病110例及癌旁乳腺组织91例。制作组织芯片,采用免疫组织化学染色法检测其ING5在细胞核和细胞质中表达情况,并分析核、质ING5蛋白与不良临床病理特征的相关性。结果乳腺癌旁组织细胞核ING5蛋白表达明显高于乳腺纤维腺瘤、乳腺腺瘤病和乳腺癌组织,腺瘤病组织细胞核ING5表达高于乳腺癌组织,乳腺癌组织细胞核ING5表达高于淋巴结转移癌细胞;癌旁乳腺组织细胞质ING5表达高于乳腺纤维腺瘤、乳腺腺瘤病和乳腺癌组织。提示ING5蛋白在人乳腺癌细胞存在核质转运。细胞核ING5高表达与远处转移呈负相关,与P53表达呈正相关,而细胞质ING5高表达与肿瘤直径和雌激素受体(ER)表达呈正相关,三阴乳腺癌(TNBC)细胞质ING5表达比非三阴乳腺癌(non-TNBC)低。结论 ING5蛋白在乳腺癌细胞存在核质转运,且细胞核ING5蛋白高表达与一些不良临床病理行为特征呈负相关。     

BMP-2和VEGF在乳腺癌的表达及意义

目的探讨骨形成蛋白-2(BMP-2)和血管内皮生长因子(VEGF)在乳腺癌的表达及其与乳腺癌临床病理因素的关系。方法应用免疫组织化学S-P法检测68例乳腺浸润性导管癌组织BMP-2和VEGF的表达情况,应用WesternBlot方法检测30例乳腺癌、5例癌旁正常组织中BMP-2和VEGF的表达情况。结果BMP-2蛋白阳性信号位于乳腺癌细胞浆内,VEGF蛋白主要分布于乳腺癌与正常乳腺上皮细胞的胞浆内。有淋巴结转移的乳腺癌组织BMP-2和VEGF的表达明显高于无淋巴结转移者(<0.01);且BMP-2和VEGF表达与临床分期有关,与患者年龄、肿瘤大小无明显相关性。Western Blot结果显示BMP-2和VEGF在有淋巴结转移患者中表达高于无淋巴结转移者(<0.01)。结论BMP-2和VEGF在乳腺癌高表达与乳腺癌的淋巴结转移和临床分期有关。     

40岁以下妇女子宫内膜癌刮宫活检的病理诊断问题

目的 探讨40岁以下妇女子宫内膜癌刮宫活检的病理诊断。方法对20例40岁以下子宫内膜癌患者的临床病理资料进行回顾性分析。结果子宫内膜样腺癌18例,腺鳞癌(腺癌伴鳞状上皮分化)1例,浆液性乳头状癌并透明细胞癌1例。子宫内膜样腺癌的组织学特点是子宫内膜腺体失去极性,细胞核变大、变圆、核仁突出,染色质粗或呈空泡状,同时子宫内膜间质消失,代之为肉芽组织或纤维组织,常有炎性反应。子宫内膜样腺癌多数仅累及浅肌层,皆无转移。1例子宫内膜腺鳞癌呈双侧卵巢转移;1例浆液性乳头状癌有盆腔淋巴结转移。结论40岁以下妇女的子宫内膜癌多数为高分化子宫内膜样腺癌,应注意与子宫内膜不典型增生及不典型息肉状腺肌瘤鉴别。     

乳腺癌p糖蛋白和nm23蛋白免疫组化研究

目的：按摩乳腺癌患者的ｐ糖蛋白表达与生存率、ｎｍ２３抑制癌转移基因与淋巴结转移之间的关系。方法：应用免疫组化Ｓ－Ｐ法，观察随访１０年以上的乳腺癌组织中ｐ糖蛋白和ｎｍ２３蛋白的表达。结果：ｐ糖蛋白和ｎｍ２３的阳性表达率分别为３６．５０％和９５．１２％。ｐ糖蛋白的阳性表达率仅与乳腺癌患者生存率有关（Ｐ〈０．０１），１０年以上较低，而与乳腺癌组织学分型，组织学分级，临床分期、淋巴结转移等无明显相关（Ｐ〉     

SIRT6和HIF-1α在三阴性乳腺癌中的表达及临床价值

目的 探索SIRT6基因与缺氧诱导因子（HIF-1α）在三阴性乳腺癌（TNBC）中的表达关系,分析二者相关性及临床价值。方法 收集2017年6月~2018年12月佳木斯大学附属第一医院病理科60例TNBC乳腺癌组织及其对应60例腋窝淋巴结病理组织,并取癌旁正常组织40例。采用免疫组化法检测癌组织、转移淋巴结及癌旁组织中SIRT6、HIF-1α表达,分析二者表达与TNBC乳腺癌临床病理参数、发生发展的关系以及二者表达的相关性。结果 SIRT6在TNBC乳腺癌组织中表达阳性率（80.00%）高于癌旁组织（24.00%）,差异有统计学意义（P＜0.05）,其表达与TNBC乳腺癌组织分化程度,临床TNM分期、转移淋巴结有关（P＜0.05）;在TNBC乳腺癌组织、癌旁组织中HIF-1α的阳性率分别为86.67%、15.00%。且HIF-1α在TNBC乳腺癌组织与癌旁组织表达差异有统计学意义（P＜0.05）。并与TNBC乳腺癌的组织分化程度,临床TNM分期、转移淋巴结相关（P＜0.05）;在TNBC乳腺癌中SIRT6与HIF-1α的表达呈正相关（r=0.823,P＜0.05）。结论 在TNBC乳腺癌中SIRT6与HIF-1α的较高的阳性表达率可能与其发生发展及早期转移有关,检测SIRT6与HIF-1α将有助于了解TNBC乳腺癌的进展及侵袭转移情况,它们有希望为TNBC乳腺癌的早期发现、治疗及预后的评估提供新的研究思路。     

Prognosis of minute carcinoma of thyroid. Follow-up study of 49 patients

Forty-nine patients with minute carcinoma of thyroid gland (clinically silent carcinoma less than 10 mm in diameter) underwent partial thyroidectomy and regional lymph node dissection. Nodal metastasis was found in 33 patients (67%). Histologically, no difference in the incidence of nodal metastasis was found between sclerosing carcinoma and nonsclerosing carcinoma. During the period of follow-up (from 3 to 18 years), neither recurrence of the carcinoma nor death was observed in 16 patients without nodal metastasis and 24 patients who had less than 4 metastatically involved nodes. In these 24 patients, most of the metastatic deposits were less than 5 mm in diameter and even the largest one did not exceed 16 mm. Recurrence without death was found in 2 of 4 patients who had many metastatically involved nodes, more than 8, or at least one large metastatic deposit measuring larger than 16 mm in diameter (moderately involved group), whereas recurrence followed by death occurred in 3 of 5 who had many involved nodes and at least one large deposit (extensively involved group). In both moderately and extensively involved groups, recurrence and death occurred in elder patients. The present study suggested that the prognosis of minute carcinoma depends on the degree of nodal involvement and age of the patient.     

PROGNOSIS OF MINUTE CARCINOMA OF THYROID| Follow-up Study of 49 Patients

Forty-nine patients with minute carcinoma of thyroid gland (clinically silent carcinoma less than 10 mm in diameter) underwent partial thyroidectomy and regional lymph node dissection. Nodal metastasis was found in 33 patients (67%). Histologically, no difference in the incidence of nodal metastasis was found between sclerosing carcinoma and nonsclerosing carcinoma. During the period of follow-up (from 3 to 18 years), neither recurrence of the carcinoma nor death was observed in 16 patients without nodal metastasis and 24 patients who had less than 4 metastatically involved nodes. In these 24 patients, most of the metastatic deposits were less than 5 mm in diameter and even the largest one did not exceed 16 mm. Recurrence without death was found in 2 of 4 patients who had many metastatically involved nodes, more than 8, or at least one large metastatic deposit measuring larger than 16 rnm in diameter (moderately involved group), whereas recurrence followed by death occurred in 3 of 5 who had many involved nodes and at least one large deposit (extensively involved group). In both moderately and extensively involved groups, recurrence and death occurred in elder patients. The present study suggested that the prognosis of minute carcinoma depends on the degree of nodal involvement and age of the patient. ACTA PATHOL. JPN. 36 1469-1475, 1986.     

Large B-cell lymphomas with a high content of reactive T cells

Twenty-one cases of large, B-cell lymphoma with an unusually high content of reactive T lymphocytes are described in this report. Fifteen patients presented with lymphoma in nodal sites and six patients presented with lymphoma in extranodal sites. With two exceptions, all patients were more than 50 years of age. The male to female ratio was 1:2. Histologically, isolated to small groups of large lymphoid cells were intermingled with many small lymphocytes. The large cells were neoplastic and exhibited B-lineage markers; immunoglobulin light chain restriction could be demonstrated in two thirds of the cases. There was a rich infiltrate of immunophenotypically mature T lymphocytes that comprised more than 50% of the cellular population. The T lymphocytes ranged from small cells with dark, round nuclei to slightly larger cells with elongated, irregular nuclei. There were occasional medium-sized blastic cells. There was also a variable infiltrate of histiocytes with or without epithelioid features, eosinophils and plasma cells, and increased vascularity. The peculiar morphologic features were also reproduced in other sites in the four patients for whom additional histologic materials were available for examination. We postulate that the abundance of T cells results either from a florid host reaction or from cytokine secretion by the neoplastic B cells, attracting T cells to the vicinity. The morphologic and immunologic features mimic those of a variety of benign lymphoproliferative diseases, angioimmunoblastic lymphadenopathy and lymphomas arising in angioimmunoblastic lymphadenopathy, peripheral T-cell lymphoma, secondary B-immunoblastic lymphoma, and Hodgkin's disease. Careful morphologic evaluation and immunophenotypic studies using leukocyte antibodies reactive in paraffin-embedded sections are of great assistance in determining a diagnosis.     

Histomorphological criteria for prognosis in breast cancer

One hundred cases of carcinoma breast were analysed with regard to histological features and clinical follow-up. Bad prognostic factors included tumour size larger than 5cms; absent or minimal intraduct component in the tumour and absent or minimal periductal elastosis. Conversely significant intraduct component in the tumour and periductal elastosis were associated with better survival. Degree of lymph nodal involvement did not influence the outcome. One reason for this unexpected finding could be that patients with more than 3 lymph node involvement were given additional chemotherapy.     

肺癌细胞外基质的表达与临床病理的关系

目的探讨原发性肺癌层粘蛋白（Ｌａｍｉｎｉｎ,ＬＮ）、纤维连接蛋白（ｆｉｂｒｏｎｅｃｔｉｎ,ＦＮ）和Ⅳ型胶原的表达与临床病理的关系。方法采用免疫组化ＬＳＡＢ法检测１８４例肺癌标本中ＬＮ、ＦＮ和Ⅳ型胶原的表达。结果ＬＮ及Ⅳ型胶原在中、高分化的肺鳞癌中的表达均明显强于低分化组（Ｐ＜００１）,在有无淋巴结转移两组间的表达差异均具显著性（Ｐ＜００５）;肺鳞癌５年以上生存组ＬＮ、Ⅳ型胶原的表达明显高于０５年内死亡组（Ｐ＜００１）,ＦＮ的表达亦有差异（Ｐ＜００５）。肺腺癌的５年以上生存组中ＦＮ、Ⅳ型胶原的表达均强于０５年内死亡组（Ｐ＜００５,００１）。结论ＬＮ和Ⅳ型胶原的表达与肺鳞癌的组织学分级和淋巴结转移有关;ＬＮ、ＦＮ、Ⅳ型胶原的表达均可作为评估肺鳞癌预后的指标,而腺癌的预后仅与ＦＮ、Ⅳ型胶原的表达有关。     

Cutaneous malignant melanoma in teenagers

Of 57 reviewed cases of malignant melanoma in teenagers, 51 had a minimum follow-up of 5 years. The histological and some clinical features of the 51 cases were compared for diagnostic and prognostic significance with those of 19 Spitz naevi and 10 other benign naevi using the SPSS-X computer program. The overall crude survival was 71% (males 64%, females 81%). Five patients with regional metastases survived more than 5 years, three of these more than 10 years. The main statistically significant features associated with a poor prognosis were Breslow thickness, diameter of ulcer, abnormal mitoses, pushing dermal borders and marginal (deep) mitoses. In comparison with Spitz naevi, features favouring malignancy were Breslow thickness, fine dusty cytoplasmic melanin pigment, marginal or abnormal mitoses, epithelioid intra-epidermal melanocytes below parakeratosis, dermal nests larger than junctional nests and the mitotic rate in the papillary dermis. Features favouring a benign lesion were diffuse maturation, spindle cells, spindle nuclei and Kamino bodies, especially if numerous or clustered. In comparison with the atypical benign naevi, significant features favouring malignancy were marginal or abnormal mitoses, single cell epidermal invasion below parakeratosis, large nuclei and irregular nuclei.     

Recurrent and non-recurrent pigmented villonodular synovitis 1

Pigmented villonodular synovitis (PVNS) is a benign intra-articular lesion. Patients are at risk for local recurrence. Factors that predict recurrence are not established. Two groups of patients were retrieved from our files. One consisted of 25 patients who had one or more recurrences within 5 years after primary surgery. The second group contained 18 historical controls free of recurrence for at least 5 years after primary surgery. Patient medical records and surgical notes were reviewed. We compared proliferative activity and DNA ploidy using digital image analysis, and other clinicopathologic features between the 2 groups of patients. The location of PVNS was significantly different between the two groups (p=0.03). In the recurrence group, there were 7 (28%) cases with disease in the knee. However, none of the controls had disease in the knee. Among recurrent cases, tumors in the knee were, on average, larger than tumors in the small joints. The size of all recurrent tumors was not significantly different than non-recurrent tumors (median of 1.8 cm versus 1.3 cm, respectively; p=0.06). There were no significant differences in age, sex, completeness of surgical removal, MIB-I index, DNA ploidy, or the percent of tumor nuclei in the diploid, S-phase, tetraploid, or hypertetraploid DNA histogram categories between the two groups. Our results indicate that recurrent PVNS tumors were more likely to be located in the knee, which may be related to larger tumor size. Patient age, sex, completeness of surgical removal, DNA ploidy, and MIB-I proliferation were not significantly different between recurrent and non-recurrent lesions.     

Clinicopathologic analysis of invasive micropapillary differentiation in breast carcinoma.

Invasive micropapillary carcinoma (IMPCa) of breast is histologically characterized by growth of cohesive tumor cell clusters within prominent clear spaces resembling dilated angiolymphatic vessels. In this study, eighty three breast carcinomas with IMPCa differentiation were identified by review of the invasive carcinoma cases in our institution and correlated retrospectively with standard clinicopathologic parameters and survival status relative to a control series of cases (mean follow up 7 years). IMPCa growth pattern was present in 6% of all breast carcinomas; it was generally a focal component in otherwise typical invasive ductal carcinoma. It comprised more than 80% of the total neoplasm in only 10 cases (12%), 50-80% of the neoplasm in 7 cases (8%), 20-50% of the neoplasm in 22 cases (26%) and less than 20% in 44 cases (53%). The mean tumor size was 4 cm, 22% invaded skin, and 58% were poorly differentiated, but 71% were ER positive. Axillary node metastases were present in 77% of cases, were typically multiple (51% had three or more positive), and usually contained an IMPCa component (81% of the cases). There was no significant difference in node status, ER status, size, tumor grade, or peritumoral angiolymphatic invasion between tumors with predominant (more than 50%) v/s focal IMPCa components. In both groups 46% of the patients died from their disease (mean interval to death = 36m). Skin involvement and nodal status were the only parameters which predicted poor survival (P =.01). The outcome of patients with IMPCa did not differ significantly from infiltrating ductal carcinomas of similar node status. In conclusion, our results suggest that IMPCa growth pattern may be a manifestation of aggressive behavior, as shown by frequent skin invasion and extensive nodal involvement. However, clinicopathologic features and outcome of IMPCa are not strongly dependent on the relative amount of micropapillary component.     

Expression of aberrant mucins in lobular carcinoma with histiocytoid feature of the breast

The clinicopathological profiles of histiocytoid carcinoma of the breast have not been well examined because of their rarity and heterogenous groups of ductal and lobular origin. A large foamy or granular cytoplasm of histiocytoid carcinoma was characterized by abundant mucin, but the properties of mucin in histiocytoid carcinoma have also not been well investigated. We selected eight cases of histiocytoid features of invasive lobular carcinoma (HLC) and compared with 14 age- and tumor size-matched cases of classical invasive lobular carcinoma (CLC). Mucin profiles were significantly different between the two groups: a fair number of HLC cases were immunopositive for MUC2 and MUC5AC (75 and 50%, respectively); in contrast, almost all CLC cases showed both as negative. Both groups were immunopositive for MUC1 and negative for MUC4 and MUC6. The prognosis of HLC was significantly worse than CLC; HLC showed shorter disease-free time than CLC (p=0.0262). In particular, HLC with MUC2 and MUC5AC expressions showed significantly shorter disease-free time and survival time than lobular carcinoma without the expressions of MUC2 and MUC5AC (p=0.0055 and p=0.0060, respectively). Therefore, the expression of 'non-mammary mucins', such as MUC2 and MUC5AC in HLC, is characteristic and indicates the more malignant transformation of tumor cells and poorer prognosis.     

p21/WAF1/Cip1 expression in invasive ductal breast carcinoma: relationship to p53, proliferation rate, and survival at 5 years

The p21/WAF1/Cipl antibody, DCS-60, was characterized by means of immunoblotting and immunofluorescence on a variety of human breast cancer cell lines. Heterogeneous staining of nuclei was observed with strong staining of cells in early G1. p21/WAF1/Cipl expression in invasive ductal, not otherwise specified breast carcinomas was determined using immunohistochemistry with this antibody and computerized image analysis. Two hundred and twenty-two tumors, including 130 from patients with no axillary node involvement, were examined. p21-positive tumor cell nuclei were found in 30% of the breast carcinomas. The percentage of tumor cell nuclei that were positive ranged from less than 1% to greater than 10%. In the whole cohort of patients, p21 expression was significantly associated with a low histological grade. In the node-negative group, there was a significant negative correlation between p21 positivity and a high (>10%) MIB-1 score. The mean MIB-1 score was significantly lower in p21-positive tumors in the whole cohort of patients (P=0.03) and in the nodenegative group (P=0.02). No association was found between p21 expression and overall survival at 5 years. With respect to p21/p53 phenotype, the significant difference in survival was noted only for the group of patients treated with adjuvant chemotherapy. The p21- p53+ phenotype had the worst survival (58% surviving 5 years), while the p21+ p53- phenotype had good survival (83% surviving 5 years; P<0.05). The results seem to suggest a correlation between p21/p53 phenotype and response to adjuvant chemotherapy.