Search

To analyze nm23-H1 protein immunohistologically in squamous cell carcinoma of the vulva.In 68 carcinomas, tumor type, grade, inflammation and vascular space involvement were determined. Formalin-fixed, paraffin-embedded tissue was stained for nm23-H1. Staining pattern, intensity and percentage of stained tumor cells were evaluated. Staining results were analyzed statistically univariately by the chi2 test, Kaplan-Meier survival analysis with log-rank test and receiver operator characteristic curves and multivariately by proportional hazard analysis.Of the tumors, 9% were negative for nm23-H1. Positive tumors showed 4 staining patterns. Tumors with inhomogeneous expression of nm23-H1 tended to have shorter disease-free and overall survival. Carcinomas with nm23-H1 staining in50% of the tumor cells more frequently developed nonlocal tumor recurrences (p= 0.018) and showed shorter disease-free survival (p = 0.017). Tumors with high nm23-H1 expression were associated with patients younger than 60 years (p = 0.02).Immunohistologic staining for nm23-H1 protein shows different staining patterns and percentages of stained cells in squamous cell carcinoma of the vulva. Tumors with inhomogeneous and low nm23-H1 expression are associated with a worse prognosis.

PURPOSE: In node-negative patients, of whom up to 30% will recur within 5 years after diagnosis, markers are still needed that identify patients at high enough risk to warrant further adjuvant treatment. In the present study we analyzed whether a correlation exists between microscopic tumor cell spread to bone marrow and to lymph nodes and attempted to determine which route is clinically more important. PATIENTS AND METHODS: According to a prospective design, bone marrow aspirates and axillary lymph nodes of level I (n = 1,590) from 150 node-negative patients with stage I or II breast cancer were analyzed immunocytochemically with monoclonal anticytokeratin (CK) antibodies. We investigated associations with prognostic factors and the effect of micrometastasis on patients’ prognosis. RESULTS: CK-positive cells in bone marrow aspirates were present in 44 (29%) of 150 breast cancer patients, whereas only 13 patients (9%) had such positive findings in lymph nodes; simultaneous microdissemination to bone marrow and lymph nodes was seen in merely two patients. No correlation of bone marrow micrometastases with other risk factors was assessed. Reduced 4-year distant disease-free and overall survival were each associated with a positive bone marrow finding (P = .032 and P = .014, respectively) but not with lymph node micrometastasis. Multivariate analysis revealed an independent prognostic effect of bone marrow micrometastasis on survival, with a hazards ratio of 6.1 (95% confidence interval, 1.2 to 31.3) for cancer-related death (P = .031) in our series. CONCLUSION: Immunocytochemical detection of micrometastatic cells in bone marrow but not in lymph nodes is an independent prognostic risk factor in node-negative breast cancer that may have implications for surgery and stratification into adjuvant therapy trials.