Adjuvant Chemotherapy in Node-negative Breast Cancer: UPA/PAI-1 Determinations for 163 Cases

Background: The urokinase-type plasminogen activator (UPA) and its main inhibitor plasminogen activator inhibitor-1 (PAI-1) are involved in tumor interactions with the microenvironment. The UPA/PAI-1 content in tumor tissue can be used to identify populations at low-or high-risk of recurrence of breast cancer, even without other standard prognostic markers. Materials and Methods: The purpose of the present study was to compare adjuvant chemotherapy decisions made by a multi-disciplinary board for 163 node-negative breast cancer cases, based on clinicopathological (CP) and UPA/PAI-1 risk assessment. Results: The UPA/PAI-1 levels identified 37% of the population as being at low risk. Adjuvant chemotherapy indication was spared in high-CP risk in 17%, but maintained in low-CP risk in 33%. Conclusion: The use of UPA/PAI-1 data did not consistently result in a decrease of adjuvant chemotherapy. This study highlighted the difficulties encountered in a local multi-disciplinary board in determining appropriate roles and weights of new prognostic markers (UPA/PAI-1 was not routinely employed in France) when no data are available for assessing their prognostic and predictive power compared to other prognostic factors.