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Prognostic impact of the inclusion of uPA/PAI-1 for adjuvant treatment decision-making in ER+/Her2− pN0 early breast cancers

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Abstract

Purpose

Intermediate-risk early breast cancer (EBC) is a heterogeneous group in which adjuvant chemotherapy decision proves to be difficult. Clinical and pathological criteria are sometimes insufficient to determine the best therapeutic options, and validated biomarkers such as uPA/PAI-1, are needed to contribute to the decision-making. The objective of this study was to evaluate the clinical outcome of an unselected ER+/HER2− pN0 EBC cohort of patients in whom the routine clinical decision process included a prospective uPA/PAI-1 determination.

Method

This monocentric retrospective study included 520 patients who underwent curative surgery in our institute between 2006 and 2011. Adjuvant therapeutic strategy was decided based on clinical–pathological data, altogether with a routine prospective determination of uPA/PAI-1 tumor levels using fresh, extemporaneously sampled tissue. We evaluated the correlation between uPA/PAI-1 levels, clinical-pathological variables, and the patient’s outcome (relapse-free survival, RFS, and overall survival, OS).

Result

Median follow-up was 5.4 years. The 5- and 10-year RFS rates were ,respectively, 95 and 89%, and the five-year OS rate was 96.3%. Forty percent of tumors had low uPA/PAI-1 levels. Seventy-five percent of patients with low uPA/PAI-1 levels did not receive chemotherapy, when 25% did. Sixty percent of patients with high uPA and/or PAI-1 levels received chemotherapy, while 40% did not. No statistical significant correlation was found between the uPA/PAI-1 levels and RFS or OS.

Conclusion

The personalization of the patients’ treatment using uPA/PAI-1 tumor levels allows the reversion of the well-known poor prognostic impact of high uPA/PAI-1 levels and strongly supports the use of this biomarker in clinical practice.

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Acknowledgements

The authors thank Hélène de Forges, Ph.D., for editorial assistance.

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Authors and Affiliations

  1. Institut Régional du Cancer de Montpellier - Val d’Aurelle, 208 avenue des Apothicaires, 34298, Montpellier, France

    Marie Viala, Marie Alexandre, Simon Thezenas, Aurélie Maran-Gonzalez, Marian Gutowski, Pierre-Emmanuel Colombo, Gilles Romieu, William Jacot & Severine Guiu

  2. Institut Médical d’Analyse Génomique, Labosud et Unité de Recherche Clinique, Clinique Beau Soleil, Montpellier, France

    Pierre-Jean Lamy

  3. INSERM U1194–IRCM (Institut de Recherche en Cancérologie de Montpellier), Montpellier, France

    Pierre-Emmanuel Colombo, William Jacot & Severine Guiu

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  1. Marie Viala
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Correspondence to Marie Viala.

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Viala, M., Alexandre, M., Thezenas, S. et al. Prognostic impact of the inclusion of uPA/PAI-1 for adjuvant treatment decision-making in ER+/Her2− pN0 early breast cancers. Breast Cancer Res Treat 165, 611–621 (2017). https://doi.org/10.1007/s10549-017-4373-7

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