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Impact of guideline-based use of uPA/PAI-1 on patient outcome in intermediate-risk early breast cancer

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Abstract

The purpose of this study was to evaluate the influence of guideline-based prospective use of uPA/PAI-1 on clinical outcome in an intermediate-risk cohort of breast cancer patients. We analyzed 381 consecutive primary breast cancer patients (2003–2011) at the breast center Ostbayern meeting the following criteria: M0/N0/estrogen receptor (ER)+/G2. Clinical–pathological data, uPA/PAI-1, and follow-up data were collected. Decisions for adjuvant chemotherapy were made upon consideration of prospectively measured uPA/PAI-1. Observed disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan–Meier estimates. Using guideline-based analysis of uPA/PAI-1, treatment with adjuvant chemotherapy was avoided in 86.5 % of patients with low uPA/PAI-1, i.e., 38.8 % of the total patient collective. Median follow-up was 52.5 months. Five-year relapse-free survival in intermediate-risk patients (N0, G2) without chemotherapy was 99 %. Five-year overall survival including all causes of death was 95 %. By using uPA/PAI-1, adjuvant chemotherapy can be avoided in a major part of patients with intermediate-risk breast cancer. Nevertheless, DFS and OS of these patients at 5 years remain excellent. The potential, but hardly measurable, benefit of adjuvant chemotherapy has to be set in contrast with its associated side effects and increased morbidity. Patients with high uPA/PAI-1 show benefit from chemotherapy. In this subgroup, a very good OS was observed as well. These findings strongly support the use of uPA/PAI-1 together with clinic-pathological parameters as an evidence-based, clinically relevant and inexpensive decision tool in the routine of a breast center.

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Acknowledgments

Statistical analysis (REK) was in part supported by the Breast Center of the University of Cologne.

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Authors and Affiliations

  1. Breast Center, Department for Gynecology and Obstetrics and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Thomas Kolben, T. M. Kolben, T. Degenhardt, M. Burgmann, C. Goess, N. Ditsch, N. Harbeck & R. Wuerstlein

  2. Breast Center, Department for Gynecology and Obstetrics, Hospital Deggendorf, Deggendorf, Germany

    D. Augustin

  3. Department for Gynecology and Obstetrics, Charité University Hospital Berlin, Berlin, Germany

    R. Armbrust

  4. REK Consulting, Otterfing, Germany

    R. Kates

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  1. Thomas Kolben
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  2. D. Augustin
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  3. R. Armbrust
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  4. T. M. Kolben
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  5. T. Degenhardt
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  6. M. Burgmann
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  7. C. Goess
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  8. N. Ditsch
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  9. R. Kates
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  10. N. Harbeck
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  11. R. Wuerstlein
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Correspondence to Thomas Kolben.

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The authors declare that they have no conflict of interest.

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This analysis was performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kolben, T., Augustin, D., Armbrust, R. et al. Impact of guideline-based use of uPA/PAI-1 on patient outcome in intermediate-risk early breast cancer. Breast Cancer Res Treat 155, 109–115 (2016). https://doi.org/10.1007/s10549-015-3653-3

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  • DOI: https://doi.org/10.1007/s10549-015-3653-3

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