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[Cancer Research 57, 1259-1263, April 1, 1997]
© 1997 American Association for Cancer Research

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The Cell Cycle Inhibitor p27 Is an Independent Prognostic Marker in Small (T1a,b) Invasive Breast Carcinomas

Puay Tan, Blake Cady, Molly Wanner, Peter Worland, Barry Cukor, Cristina Magi-Galluzzi, Philip Lavin, Giulio Draetta, Michele Pagano1 and Massimo Loda2

Departments of Pathology [P. T., M. W., B. Cu., C. M-G., M. L.] and Surgery [B. Ca.], Beth Israel Deaconess Medical Center, West Campus, Harvard Medical School, Boston, Massachusetts 02215; Mitotix, Inc., Cambridge, Massachusetts 02139 [P. W.]; Boston Biostatistics Research Foundation, Inc., Framingham, Massachusetts 01702 [P. L.]; European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy [G. D.]; and Department of Pathology and Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, New York 10016 [M. P.]

Breast carcinomas ≤1 cm in size (T1a,b) are being detected more frequently as a result of screening. Because traditional prognostic parameters are either lacking (tumor size) or rare (nodal metastases), a marker(s) is needed to identify the subset of patients who could benefit from adjuvant therapy. A retrospective series of 202 patients with stage T1a,b invasive breast carcinomas was evaluated. The clinicopathological features (age, histological grade, extensive in situ carcinoma, hormone receptor status, and nodal metastasis) as well as microvessel density and the expression of c-erb-B2, p53, MIB-1/Ki-67, and cdc25B were assessed. In addition, expression of the cell cycle inhibitor p27 was evaluated.

Nineteen patients (18% of patients who had axillary dissection) had locoregional lymph node metastases. Forty-two % of them died of disease (median survival, 112 months), whereas mortality was 11% in node-negative patients (median survival, 168 months; P = 0.0055). Patients with low p27 expression had a median survival of 139 months (17% mortality) versus 174 months (9% mortality) in the group with high p27 expression (P = 0.0233). Lack of p27 was associated with poor prognosis when node-positive patients were excluded (P = 0.0252). Nodal status and low p27 were found to be the only independent prognostic parameters by both univariate and multivariate analysis, with relative risks of dying of disease of 4.9 (P = 0.001) and 3.4 (P = 0.0306), respectively.

Assessment of p27, which yields prognostic information in node-negative patients, could be useful to identify patients with small, invasive breast carcinomas who might benefit from adjuvant therapy.

1 Supported in part by NIH grant CA 66229-02.

2 To whom requests for reprints should be addressed, at Department of Pathology, Laboratory of Molecular Pathology, Beth Israel Deaconess Medical Center, West Campus, One Deaconess Road, Boston, MA 02215. Phone: (617) 632-0997; Fax: (617) 632-0989; E-mail: mloda@west.bidmc.harvard.edu.

Received 12/23/96. Accepted 2/14/97.




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G. V. Thomas, K. Szigeti, M. Murphy, G. Draetta, M. Pagano, and M. Loda
Down-Regulation of p27 Is Associated with Development of Colorectal Adenocarcinoma Metastases
Am. J. Pathol., September 1, 1998; 153(3): 681 - 687.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
A. M. De Marzo, A. K. Meeker, J. I. Epstein, and D. S. Coffey
Prostate Stem Cell Compartments : Expression of the Cell Cycle Inhibitor p27Kip1 inNormal, Hyperplastic, and Neoplastic Cells
Am. J. Pathol., September 1, 1998; 153(3): 911 - 919.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
H. Kawana, J.-i. Tamaru, T. Tanaka, A. Hirai, Y. Saito, M. Kitagawa, A. Mikata, K. Harigaya, and T. Kuriyama
Role of p27Kip1 and Cyclin-Dependent Kinase 2 in the Proliferation of Non-Small Cell Lung Cancer
Am. J. Pathol., August 1, 1998; 153(2): 505 - 513.
[Abstract] [Full Text] [PDF]


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BloodHome page
M. Erlanson, C. Portin, B. Linderholm, J. Lindh, G. Roos, and G. Landberg
Expression of Cyclin E and the Cyclin-Dependent Kinase Inhibitor p27 in Malignant Lymphomas---Prognostic Implications
Blood, August 1, 1998; 92(3): 770 - 777.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
L. Quintanilla-Martinez, C. Thieblemont, F. Fend, S. Kumar, M. Pinyol, E. Campo, E. S. Jaffe, and M. Raffeld
Mantle Cell Lymphomas Lack Expression of p27kip1, a Cyclin-Dependent Kinase Inhibitor
Am. J. Pathol., July 1, 1998; 153(1): 175 - 182.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
V. A. Florenes, G. M. Mælandsmo, R. S. Kerbel, J. M. Slingerland, J. M. Nesland, and R. Holm
Protein Expression of the Cell-Cycle Inhibitor p27Kip1 in Malignant Melanoma : Inverse Correlation with Disease-Free Survival
Am. J. Pathol., July 1, 1998; 153(1): 305 - 312.
[Abstract] [Full Text] [PDF]


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BloodHome page
R. Vrhovac, A. Delmer, R. Tang, J.-P. Marie, R. Zittoun, and F. Ajchenbaum-Cymbalista
Prognostic Significance of the Cell Cycle Inhibitor p27Kip1 in Chronic B-Cell Lymphocytic Leukemia
Blood, June 15, 1998; 91(12): 4694 - 4700.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
J. M. Trowbridge, I. Rogatsky, and M. J. Garabedian
Regulation of estrogen receptor transcriptional enhancement by the cyclin A/Cdk2 complex
PNAS, September 16, 1997; 94(19): 10132 - 10137.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
N. Ishida, M. Kitagawa, S. Hatakeyama, and K.-i. Nakayama
Phosphorylation at Serine 10, a Major Phosphorylation Site of p27Kip1, Increases Its Protein Stability
J. Biol. Chem., August 11, 2000; 275(33): 25146 - 25154.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
V. O'Brien, G. J. Grindlay, and M. S. Campo
Cell Transformation by the E5/E8 Protein of Bovine Papillomavirus Type 4. p27Kip1, ELEVATED THROUGH INCREASED PROTEIN SYNTHESIS, IS SEQUESTERED BY CYCLIN D1-CDK4 COMPLEXES
J. Biol. Chem., August 31, 2001; 276(36): 33861 - 33868.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
J. C. H. Donovan, A. Milic, and J. M. Slingerland
Constitutive MEK/MAPK Activation Leads to p27Kip1 Deregulation and Antiestrogen Resistance in Human Breast Cancer Cells
J. Biol. Chem., October 26, 2001; 276(44): 40888 - 40895.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
M. Gstaiger, R. Jordan, M. Lim, C. Catzavelos, J. Mestan, J. Slingerland, and W. Krek
Skp2 is oncogenic and overexpressed in human cancers
PNAS, April 24, 2001; 98(9): 5043 - 5048.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
S. Cariou, J. C. H. Donovan, W. M. Flanagan, A. Milic, N. Bhattacharya, and J. M. Slingerland
Down-regulation of p21WAF1/CIP1 or p27Kip1 abrogates antiestrogen-mediated cell cycle arrest in human breast cancer cells
PNAS, August 1, 2000; 97(16): 9042 - 9046.
[Abstract] [Full Text] [PDF]




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