Abstract
BackgroundThe aim of the present study was to determine the prognostic relevance of thymidine labeling index (TLI) in patients with breast cancer.MethodsTLI of the primary tumor was measured in 268 patients at the time of the surgical biopsy by an in vitro method.ResultsFifty-four patients had stage I disease, and 138 patients had stage II disease, and 76 patients had stage III disease. One hundred-four patients were found to have low TLI-index (<3%), and 164 patients had high TLI-index (≥3%). The median follow-up was 71.5 months (range, 6–138 months). The 5-year overall survival (OS) and disease free survival (DFS) rates was 84% and 74%, respectively. Lymph node involvement, tumor size more than 2 cm, high nuclear grade and estrogen receptor negativity were found to be associated with poorer DFS and OS rates. On subgroup analysis, however, the 5-year OS rate was significantly higher in the low TLI-group than in the high TLI-group in patients with stage I disease (100% vs 76%, p = 0.05).ConclusionOur findings suggest that the prognostic significance of TLI appears to be limited to early breast cancer that might help to distinguish patients who need more aggressive adjuvant treatment.
Highlights
The aim of the present study was to determine the prognostic relevance of thymidine labeling index (TLI) in patients with breast cancer
We investigated the prognostic value of TLI in our patient population with operable breast cancer by analyzing various associations between TLI and tumor characteristics and outcome by comparing with other previously established prognostic factors
We previously reported that TLI was a strong independent prognostic factor affecting overall survival (OS) in locally advanced breast cancer among the other established clinical and biological parameters [9]
Summary
The aim of the present study was to determine the prognostic relevance of thymidine labeling index (TLI) in patients with breast cancer. Great efforts have been made to separate patients who need agressive systemic treatment due to high-risk of recurrence, from those in whom loco-regional treatment is sufficient For this purpose, increasing number of biological markers such as hormone receptors, bcl-2, p53 mutations, c-erbB2 over-expression, Ki-67, nuclear DNA ploidy, and microvessel density have been proposed as potential prognostic markers in breast cancer [1,2,3,4,5]. Many of these markers appeared to be promising in initial reports but eventually failed to maintain their predictive value on clinical outcome. The main reasons for the conflicting results might be due to the techniqual difficulties in quantifying TLI and the heterogenicity of patient series
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