尿激酶型纤溶酶原激活物在乳腺癌中的表达及意义

目的 研究尿激酶型纤溶酶原激活物（ｕＰＡ）在乳腺癌组织中的表达及其临床意义。方法 应用免疫组化ＳＡＢＣ法检测１００例原发性乳腺癌患者中的ｕＰＡ的表达。结果 １０例乳腺癌患者中,ｕＰＡ高表达５５例,占５５．０％;低表达者４５例,占４５．０％;ｕＰＡ表达与ＴＮＭ分期、淋巴结状况及肿瘤大小相关,与年龄、月经状况、ＷＲ无关。ｕＰＡ高表达者的无病生存期和总生存期低于ｕＰＡ低表达者。单因素分析显示,ｕＰＡ的预     

血管形成和纤维蛋白降解作用与乳腺癌侵袭转移的关系

目的研究血管形成和纤维蛋白降解作用与乳腺癌侵袭转移的关系。方法应用免疫组化方法,检测110例原发性乳腺癌患者中尿激酶型纤溶酶原激活物(uPA)和微血管密度(MVD)的表达,并结合临床、病理及随访资料进行分析。结果110例患者中,uPA高表达者59例,占53．6％;低表达者51例,占46．4％。MVD计数高者53例,占48．2％;计数低者57例,占51．8％。uPA表达与肿瘤大小、淋巴转移和TNM分期有显著相关性,MVD与肿瘤大小、TNM分期有显著相关性,二者表达与患者年龄、月经状况和激素受体状况无关。uPA和MVD高表达者的无复发生存期均低于低表达者的生存期,特别是uPA和MVD均为高表达者更易复发转移。多因素分析显示,uPA和MVD是影响无复发生存期的主要因素。结论血管形成和纤维蛋白降解作用与乳腺癌的侵袭转移行为密切相关,uPA和MVD可能是预测乳腺癌患者复发转移的独立预后因素。     

Significance of microvascular density and vascular endothelial growth factor in breast cancer

OBJECTIVE: To study the significance of vascular endothelial growth factor (VEGF) and microvascular density (MVD) expression in breast cancer. METHODS: The expression of MVD and VEGF was studied in 81 patients with primary breast cancer by SP immunohistochemical technique. RESULTS: There were 49 patients with high VEGF expression (60.5%) and 35 patients with high MVD expression (43.2%). There was significant correlation between VEGF or MVD expression and TNM stage, but not age, tumor size, ER expression or lymph node status. VEGF was significantly related with MVD expression. Univariate analysis showed that patients with low expression of VEGF and MVD had longer disease free survival (DFS) and overall survival (OS). Grouping univariate analysis showed that VEGF had significant correlation with the DFS of all grouped patients and the OS of patients with LN(+) or stage III lesions. MVD had significant correlation with the DFS and OS of LN(+) patients and the DFS of stage III lesion patients. Multivariate analysis showed that MVD was a risk predictor because of its positive statistic value, the higher expression, the shorter survival time of the patients. CONCLUSION: Both VEGF and MVD are useful prognostic factors in breast cancer. MVD appears to be a strong and independent biologic marker for breast cancer prognosis.     

CD44v6在乳腺浸润性导管癌组织中的表达及其临床意义

背景与目的:近年研究表明,CD44v6与乳腺癌的发生、侵袭和转移密切相关,但其与乳腺癌预后关系的报道结果并不一致。本研究探讨CD44v6在乳腺癌和乳腺癌旁非癌组织中的表达及其与乳腺癌临床病理因素的关系以及对乳腺癌患者预后的预测意义。方法:采用免疫组织化学SP法检测84例乳腺浸润性导管癌和20例癌旁非癌乳腺组织中CD44v6的表达。采用SPSS10.0软件统计分析CD44v6表达与各病理因素的关系,采用Cox比例风险模型分析影响预后的因素。结果:CD44v6在乳腺浸润性导管癌上皮细胞的表达(78.6%)明显高于癌旁非癌乳腺组织上皮(5.0%),差异有显著性(P<0.05);CD44v6的表达与乳腺癌的TNM分期、肿瘤大小、淋巴结转移状况密切相关;中位随访时间为60个月,CD44v6阴性组的总体生存情况优于CD44v6阳性组,有显著性差异(P<0.05),而且随着CD44v6表达的增强,总体生存曲线有逐渐下降的趋势。Cox比例风险模型多因素的预后分析结果显示,ER、TNM分期、CD44v6均是影响预后的独立因素(P<0.05)。结论:CD44v6在乳腺癌组织中的表达明显升高;CD44v6的表达与乳腺癌患者的TNM分期、肿瘤大小、淋巴结转移呈正相关;CD44v6表达升高可作为预测乳腺癌预后的独立指标之一。     

Angiogenesis, p53, and c-erbB-2 immunoreactivity and clinicopathological features in male breast cancer

BACKGROUND AND OBJECTIVES: p53, c-erbB-2, and tumor microvascular density have been shown to be potential prognostic tools in female breast cancer. Our objective was to assess the significance of these biomarkers as prognostic factors in infiltrating male breast cancer. METHODS: A retrospective study of expression of p53, c-erbB-2, and tumor microvascular density was done on a group of 26 male breast cancer patients. Biotin-streptavidin immunohistochemical study with specific anti-p53, anti-c-erbB-2, and anti-CD34 antibodies was carried out on paraffin sections of breast carcinoma. The data of expression of the biomarkers were merged with clinicopathological data such as tumor grade, T class, TNM stage, estrogen receptor status, tumor recurrence, and patient survival. RESULTS: p53 and c-erbB-2 were expressed in 46% and 39% of carcinomas, respectively. No correlation was found between positive immunoreactivity of p53, and tumor grade, size, T class, TNM stage, and survival. Nor was any relation found between tumor size, T class, TNM stage, survival, and c-erbB-2 overexpression. c-erbB-2 overexpression was significantly higher in high grade carcinomas. Estrogen receptor (ER) were positive in 21 out of 26 of tumors (81%). No trends were observed between estrogen receptor status and clinicopathological parameters or survival (data not shown). There was a positive correlation between mean microvascular density (MVD), advanced T class, and survival: higher MVD counts were found in patients with advanced tumors and in those who had tumor relapses or died of metastatic disease. CONCLUSIONS: This study suggests that tumor microvascular density may serve as a potential prognostic tool in male breast carcinoma.     

原发性乳腺癌患者术前血清中糖类抗原153癌胚抗原和组织多肽特异性抗原水平与临床病理特征和预后的关系

目的 探讨原发性乳腺癌患者术前血清中糖类抗原153( CA153)、癌胚抗原(CEA)和组织多肽特异性抗原(TPS)水平与患者临床病理特征和预后的关系.方法 对386例Ⅰ～Ⅳ期原发性乳腺癌患者的临床资料进行严格随访,回顾性分析患者术前血清中CA153、CEA和TPS水平与乳腺癌临床病理特征和预后的关系.结果 分别有383、382和324例患者进行了术前CA153、CEA和TPS的检测,平均表达水平分别为(21.46±34.88)U/ml、(1.53±7.95)μg/L和(224.87±436.19) AU/ml,CA153、CEA和TPS的阳性表达率分别为10.7％ (41/383)、7.6％ (29/382)和63.9％ (207/324).原发性乳腺癌患者术前血清CA153的表达水平与患者的年龄和肿瘤大小显著相关(均P＜0.05),CEA的表达水平与肿瘤大小显著相关(P＜0.05),TPS的表达水平与肿瘤大小和淋巴结转移状况显著相关(均P＜0.05).术前血清CA153、CEA和TPS阳性表达患者的总生存率显著低于阴性患者(均P＜0.05).Cox多因素分析表明,ER的表达水平以及术前CA153的表达水平是影响乳腺癌患者预后的独立因素(均P＜0.05),其中术前CA153水平增高是危险因素,而ER阳性表达则是保护因素.结论 术前血清CA153、CEA和TPS的表达水平与乳腺癌患者的临床病理特征和预后有关,CA153是影响乳腺癌患者预后的独立因素,CA153表达水平增高者的预后较差.     

乳腺癌组织CK5／6的表达及与预后关系的研究

目的：分析乳腺癌组织细胞角蛋白5／6（cytokeratin5／6,CK5／6）表达及其与患者预后的关系。方法：收集北京协和医学院肿瘤医院2000-01-01-2000-12-31手术的乳腺癌石蜡组织标本共307例,制作成乳腺癌组织芯片。采用免疫组织化学MaxVision二步法检测乳腺癌组织cK5／6蛋白的表达,应用SPSS15．0统计软件分析cK5／6与乳腺癌患者的年龄、月经、妊娠、哺乳、肿瘤大小、TNM分期、ER、PR和HER-2等因素之间的关系及在乳腺癌患者预后中的价值。结果：乳腺癌组织CK5／6阳性表达率为23．9％（68／285）。单因素生存分析显示,CK5／6蛋白的表达与患者的总生存率和无病生存率有关,P值分别为0．022和0．023;将分期、ER、PR、HER-2和CK5／6等指标进行Cox多因素生存分析,显示CK5／6是与总生存相关的独立的预后因素（P=0．023）,乳腺癌组织CK5／6蛋白高表达提示有较差的临床预后。结论：CK5／6高表达的乳腺癌患者较低表达患者有较差的预后,CK5／6是与乳腺癌总生存相关的独立预后因素。     

70岁以上老年浸润性乳腺癌患者的临床病理特点、治疗现状及预后分析

目的 分析70岁以上老年女性浸润性乳腺癌患者的临床及病理特点、治疗方式、生存情况及影响预后的因素。方法 收集178例70岁以上老年浸润性乳腺癌患者的临床资料、随访生存情况,统计分析其临床病理特点、生存率及影响治疗方案选择和预后的因素。结果 全组178例患者,83.7%的患者合并至少一种伴随疾病。T1、T2期患者分别占46.1%、36.5%,多为浸润性导管癌,ER和（或）PR阳性的患者占81.6%。多因素分析显示肿瘤大小、淋巴结转移、TNM分期、PR状态、并发症情况、腋窝手术方式是影响患者是否接受化疗的独立因素;年龄是影响患者是否接受放疗的唯一独立因素。中位随访51月,3、5年无病生存率分别为91.8%和80.5%,3年的总生存率为94%。肿瘤大小、淋巴结转移情况、TNM分期、是否行手术治疗是影响老年浸润性乳腺癌患者生存的影响因素。治疗不足,尤其是化疗不足会影响老年患者生存,但结果差异未见统计学意义。结论 老年浸润性乳腺癌以早期患者为主,预后较好,影响治疗的主要因素集中在肿瘤分期、分子分型及年龄并发症情况。多数患者死亡原因为非乳腺癌相关原因,手术治疗仍是提高患者生存的主要干预手段。     

原发性乳腺癌组织中人乳腺珠蛋白的表达及意义

目的研究人乳腺珠蛋白（hMAM）在乳腺组织中表达的特异性, hMAM 的表达与各临床病理特征以及与乳腺癌预后的关系。方法运用免疫组织化学的方法分析142 例原发性乳腺癌组织,103例其他肿瘤组织,30 例正常乳腺组织,30 例乳腺良性肿瘤中的hMAM表达情况,并结合乳腺癌患者的临床病理资料和生存情况进行分析。结果hMAM只在乳腺组织中表达,在原发性乳腺癌中有70.4%的阳性表达。hMAM的表达与年龄、临床分级分期、肿块大小、腋淋巴结状态、病理类型、PR、HER2 状态均无相关性,与ER呈正相关。生存分析显示,hMAM 阳性患者预后明显好于hMAM 阴性患者,Cox回归示年龄、临床分期、ER、hMAM状态均对乳腺癌的术后生存时间有影响。结论hMAM具有理想的乳腺组织表达特异性,在原发性乳腺癌组织中有较高的表达率同时具备较高的敏感度和特异性。生存分析显示hMAM 可以作为评估原发性乳腺癌患者预后的重要参考指标。     

长链非编码RNA PCBP1-AS1在乳腺癌组织中的表达及临床意义

目的:研究多聚胞嘧啶结合蛋白1反义长链非编码RNA（lncRNA PCBP1-AS1）在乳腺癌组织中的表达及临床意义。方法:选取2013年5月至2016年4月在本院进行手术治疗的105例乳腺癌患者作为研究对象,将切除的癌组织作为试验组,同时取同一患者的癌旁（距肿瘤边缘＞2 cm）组织作为对照组。用实时荧光定量PCR（qRT-PCR）检测lncRNA PCBP1-AS1表达情况;分析lncRNA PCBP1-AS1与乳腺癌病理参数关系;分析lncRNA PCBP1-AS1表达情况对乳腺癌患者生存情况的影响;Cox回归分析影响乳腺癌的预后因素。结果:试验组lncRNA PCBP1-AS1表达明显低于对照组（P<0.05）;乳腺癌患者癌组织中lncRNA PCBP1-AS1表达水平与患者年龄、肿瘤直径、绝经情况和病理类型相关性不明显（P>0.05）,与淋巴结转移和TNM分期有关（P<0.05）;绘制乳腺癌患者术后36个月生存曲线,lncRNA PCBP1-AS1高表达患者的总生存率明显高于低表达患者（P<0.05）;对lncRNA PCBP1-AS1表达、淋巴结转移和TNM分期进行Cox回归分析,显示lncRNA PCBP1-AS1表达是影响乳腺癌患者预后的独立保护因素,TNM分期是影响乳腺癌患者预后的独立危险因素。结论:乳腺癌患者癌组织中lncRNA PCBP1-AS1呈低表达,其表达水平与淋巴结转移和TNM分期有关,lncRNA PCBP1-AS1表达是乳腺癌预后独立保护因素,可作为乳腺癌预后判断指标之一,有望成为乳腺癌治疗的潜在靶点。     

Model for breast cancer survival: relative prognostic roles of axillary nodal status, TNM stage, estrogen receptor concentration, and tumor necrosis

The independent prognostic effects of certain clinical and pathological variables measured at the time of primary diagnosis were assessed with Cox multivariate regression analysis. The 859 patients with primary breast cancer, on which the proportional hazards model was based, had a median follow-up of 60 months. Axillary nodal status (categorized as N0, N1-3 or N4+) was the most significant and independent factor in overall survival, but inclusion of TNM stage, estrogen receptor (ER) concentration and tumor necrosis significantly improved survival predictions. Predictions made with the model showed striking subset survival differences within stage: 5-year survival from 36% (N4+, loge[ER] = 0, marked necrosis) to 96% (N0, loge[ER] = 6, no necrosis) in TNM I, and from 0 to 70% for the same categories in TNM IV. Results of the model were used to classify patients into four distinct risk groups according to a derived hazard index. An 8-fold variation in survival was seen with the highest (greater than 3) to lowest index values (less than 1). Each hazard index level included patients with varied combinations of the above factors, but could be considered to denote the same degree of risk of breast cancer mortality. A model with ER concentration, nodal status, and tumor necrosis was found to best predict survival after disease recurrence in 369 patients, thus confirming the enduring biological significance of these factors.     

细胞周期蛋白D1、CDK4在乳腺癌中的表达及其临床意义

目的：研究乳腺癌组织周期蛋白D1、CDK4的蛋白表达定位、表达水平,及与P21蛋白表达、与临床病理指标的关系及其预后意义。方法：①应用免疫组织化学染色方法,检测106例乳腺癌组织石蜡切片上的周期蛋白D1、CDK4的蛋白定位和蛋白表达,比较其与P21的蛋白表达,与临床病理学指标,如病理类型、组织学分型、组织学分级、淋巴结状态、雌激素受体状态、TNM分期等之间的关系;②对周期蛋白D1、CDK4、P21及临床病理指标如肿瘤的组织学分级、淋巴结状态、TNM分期、ER状态等,应用Kaplan-Meier法Log-rank检验进行单因素生存分析,应用Cox比例风险模型进行多因素生存分析。结果：①周期蛋白D1表达定位于细胞核、CDK4的表达位于细胞质和细胞核,周期蛋白D1的阳性率为30.2%,CDK4的阳性率为53.8%。②周期蛋白D1及CDK4的表达与乳腺癌的病理诊断组织学分型、组织学分级、ER状态、临床TNM分期、淋巴结状态、P21蛋白表达水平无关（P＞0.05)。周期蛋白D1的蛋白表达与DCK4的蛋白表达相关（P＜0.05)。③单因素分析提示影响140个月无瘤生存率及总生存率的因素有：临床TNM分期、组织学分级、腋淋巴结状态、周期蛋白D1的蛋白表达（P＜0.05)。在无腋淋巴结转移亚组周期蛋白D1蛋白表达单因素生存分析无统计学意义（P＞0.05),在腋淋巴结有转移亚组周期蛋白D1是影响140个月无瘤生存率和总生存率的因素（P＜0.01)。④多因素生存分析结果表明周期蛋白D1、P21蛋白表达、组织学分级是影响乳腺癌患者无瘤生存率和总生存率的独立预后因素（P＜0.05)。结论：周期蛋白D1、P21的蛋白表达水平及组织学分级可能是判断乳腺癌术后生存的有效指标,综合应用这些指标可能更有帮助。     

Prognostic value of p53 protein expression in breast cancer; an immunohistochemical analysis of frozen sections in 514 Japanese women

BACKGROUND: Although the prognostic value of p53 protein has been extensively studied in breast cancer, there have so far been few immunohistochemical studies of p53 protein using frozen sections in a large series of Japanese women with breast cancer. PATIENTS AND METHODS: Immunohistochemical staining for p53 protein was performed on frozen sections from 514 Japanese patients with breast cancer with a mean follow-up duration of 31 months. RESULTS: Two hundred and eight (40.5%) of 514 cases showed nuclear accumulation of p53 protein. There was a significant inverse correlation between p53 protein and estrogen receptor (ER) status. The patients who were positive for p53 protein had a significantly worse outcome in terms of both disease free survival (DFS) (p<0.0001) and overall survival (OS) (p=0.0411) than those negative for p53 protein. The same effect on DFS was seen in subgroups divided either by nodal status or ER status. Multivariate analyses indicated that nodal status, ER and p53 protein were all independent prognostic factors for DFS. The nodal status, ER and tumor size were independent prognostic factors for OS, and p53 protein status was still an independent prognostic factor for DFS in subgroups divided either by nodal status or ER status. CONCLUSION: Our findings demonstrated the prognostic value of p53 protein expression for the early recurrence of breast cancer, and the prognostic value of p53 protein expression was independent from that of both the nodal status and ER status in breast cancer.     

烟酰胺磷酸核糖基转移酶在乳腺癌中的表达及临床意义

目的探讨烟酰胺磷酸核糖基转移酶(Nampt)在乳腺癌组织中的表达并确定其与临床病理特征之间的关系及对患者预后的影响。方法采用免疫组化法分析83例乳腺癌患者的癌组织和癌旁正常乳腺组织中Nampt的表达情况。Nampt表达与临床病理变量间的关系采用χ2检验;Nampt对总生存率的预后价值采用Kaplan-Meier法评价。结果 Nampt在乳腺癌组织中表达升高,其表达程度与肿瘤大小、淋巴结转移及TNM分期相关;在雌激素受体(ER)和孕激素受体(PR)表达阴性的癌组织中Nampt表达更高;Nampt高表达与较低的无病生存率及总生存率相关。结论乳腺癌组织中高表达的Nampt与更多的恶性肿瘤生物学行为及不良预后相关。     

178例三阴性乳腺癌的临床病理特征及生存分析

 目的
探讨三阴性乳腺癌(TNBC)患者的临床病理特点、生存情况和预后影响因素。方法收集雌激素受体(ER)、孕激素受体
(PR)和人表皮生长因子受体2(HER2)均阴性的178例乳腺癌患者的临床病理资料,观察其长期生存状况。分析其临床
特点及影响预后的因素。结果有乳腺癌家族史的患者4例。主要病理类型为浸润性导管癌(155/178,87.1%）。组织
学分级多为Ⅲ级(53.1%）。中位肿瘤最大径2.8 cm(0.2～12 cm）,T1、T2期患者160例占89.9%。108例(61.7%）
患者无淋巴结转移。分期为Ⅰ、Ⅱ、Ⅲ期的患者分别有60例(33.7％)、81例(45.5％)、31例(17.4％)。58例(48.3
％)患者p53阳性。中位随访时间74月(10～156月）,5年
无病生存(DFS)和总生存(OS)率分别是76.9%和86.1%。单因素分析显示T分期、临床分期及淋巴结转移对DFS和OS
均有显著影响。多因素分析显示,淋巴结转移是DFS及OS的独立影响因素。而术后分期是OS的影响因素。共有41例
患者出现复发转移及第二原发肿瘤,常见转移部位依次为骨转移、局部复发或同侧锁骨上淋巴结转移、肺或胸膜转
移、肝转移及脑转移。结论 本组TNBC肿瘤直径较小,组织学分级低分化比例较高(53.1%）。复发转移以骨转移、
局部复发及肺转移为主。淋巴结转移及术后分期是总生存的独立危险因素。     

Breast Cancer in Young Women: Prognostic Factors and Clinicopathological Features

Objective:The aim of this study was to determine most significant prognostic factor for overall survival of invasiveduct operable breast cancer from clinical stage, pathological stage, epidemiological, anatomic and cellular andmolecular genetic factors. Materials and Methods: Research design was prospective cohort. Duct invasive operablebreast cancer patients who were diagnosed and treated with standard protocol since 1993, followed prospectivelyuntil November 2003 by clinical stage, pathological stage, age, tumor size, lymph node status, histological grade,mitotic index, ER,PR, c-erbB2, p53 and MIB-1, until revealed outcome (death). Prognostic factor was analyzedunivariately for overall survival with Kaplan Meier method. Difference between two survival group was analyzedwith log- rank test. Independent prognostic factor was analyzed multivariately using proportional hazard (Cox)regression. Results:With univariate analysis, significant prognostic factors for overall survival were clinical stage(p<0.001), pathological stage (p<0.001), tumor size (p<0.001), lymph node status (p<0.001) and adjuvant chemotherapy(p <0.005). Multivariately, most significant prognostic factors for survival were lymph node status (p = 0.001 ; Expβ = 7.775; 95% CI: 2.276 – 26.56) and clinical stage (p = 0.029; Exp β= 2.142; 95% CI: 1.081 – 4.244). Conclusion:Independent prognostic factors for survival are lymph node status and clinical stage.     

S-phase fraction and urokinase plasminogen activator are better markers for distant recurrences than Nottingham Prognostic Index and histologic grade in a prospective study of premenopausal lymph node-negative breast cancer.

PURPOSE: Histologic grade, Nottingham Prognostic Index (NPI), estrogen receptor (ER) and progesterone receptor (PgR) status, and tumor size have previously been shown to be important prognostic indicators for distant recurrence of breast cancer. The purpose of this study was to compare the prognostic value of these factors with flow cytometric S-phase fraction (SPF), urokinase plasminogen activator (uPA), and plasminogen activator inhibitor type 1 (PAI-1) in premenopausal patients with lymph node-negative breast cancer. PATIENTS AND METHODS: In 237 consecutive premenopausal patients with lymph node-negative breast cancer and freshly frozen tumor material available, SPF, ER and PgR status, uPA and its inhibitor PAI-1, histologic grade, and NPI were evaluated. RESULTS: SPF was univariately the most powerful prognostic factor for distant recurrence, followed by uPA, histologic grade, PgR, age, ER, NPI, and PAI-1, the latter being nonsignificant. Multivariate analysis revealed that neither NPI nor histologic grade was significant after adjustment for SPF, a fact that may be explained by the strong association between these factors. uPA was, however, an independent prognostic factor in addition to SPF, NPI, or histologic grade. CONCLUSION: In this prospective study, SPF and uPA were found to be independent prognostic factors in premenopausal women with lymph node-negative breast cancer. We suggest that SPF, if performed under standardized conditions, can replace histologic grade as a selection instrument for adjuvant medical treatment. The value of the combination of SPF and uPA needs to be confirmed in an independent prospective trial.     

Polyadenylate polymerase enzymatic activity in mammary tumor cytosols: A new independent prognostic marker in primary breast cancer

Polyadenylate polymerase (PAP) is one of the enzymes involved in the formation of the polyadenylate tail of the 3' end of mRNA. High levels of PAP activity were associated with rapidly proliferating cells. Here we evaluate the prognostic value of PAP activity in breast cancer patients. PAP specific activity values were measured by a highly sensitive assay in the tumor cytosols of 228 women with primary breast cancer. The median follow-up period was 58 months. PAP specific activity values ranged from 2.1-39.4 units/mg protein in the breast tumor cytosols, and the activity was correlated with the level of expression of the antigen. An optimal cutoff value of 5.5 units/mg extracted protein was first defined by statistical analysis. PAP status was then compared with other established prognostic factors in terms of relapse-free survival (RFS) and overall survival (OS). PAP activity levels had a tendency to increase with tumor-node-metastasis (TNM) stage and were higher in node-positive patients. Evaluation of the prognostic value of PAP was performed using univariate and multivariate analyses. Univariate analysis showed that PAP-positive patients had a less favorable prognosis for both RFS (relative risk (RR) = 2.35; P < 0.001] and OS (RR = 3.15; P < 0.001). PAP significantly added to the prognostic power for RFS (RR = 2.51; P = 0.0012) and OS (RR = 4.21; P < 0.001) in multivariate analysis, whereas patient age, tumor size, and nodal and ER status remained independent factors for predicting survival. When only node-negative patients were examined, PAP was found to be an independent factor for predicting RFS (RR = 3.68; P = 0.0032) and OS (RR = 4.81; P < 0.001). PAP did not appear to have a prognostic significance for node-positive patients. PAP is a new prognostic factor for early recurrence and death in breast cancer patients. Our results suggest that PAP may be used as an independent unfavorable prognostic factor in node-negative breast cancer patients because there were no significant associations between PAP and the other prognostic indicators evaluated in this group of patients.