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Logo of jclinpathJournal of Clinical PathologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Clin Pathol. 2001 November; 54(11): 866–870.
PMCID: PMC1731310

p21waf correlates with DNA replication but not with prognosis in invasive breast cancer


Background/Aims—p21waf plays a central role both in the regulation of the cell cycle and in DNA replication. Accordingly, p21waf is a putative tumour suppressor. The role of p21waf expression in breast cancer is still unclear, particularly with respect to the clinical situation. Therefore, this retrospective study was designed to investigate the value of immunohistochemically detected p21waf expression in invasive breast cancer.

Methods—Cellular expression of p21waf was assessed in 307 breast cancer tissues by immunohistochemistry using the monoclonal antibody, clone 4D10. The data were correlated to established and functional factors of prognosis (age, menopausal status, tumour size, nodal status, tumour grade, receptor status, proliferating cell nuclear antigen (PCNA) expression, Her-2/neu expression, and p53 expression), and to clinical follow up (median observation time, 82 months).

Results—Ninety nine of 307 (32.2%) tumour tissues were considered p21waf positive (nuclear staining). In the entire study group, p21waf expression correlated only with increased PCNA expression (χ2 test: p = 0.029), and with none of the other investigated markers. In node negative patients (n = 134), p21waf expression correlated with increased tumour size and increased PCNA expression, whereas the node positive subgroup (n = 161) showed no correlation with these parameters (lymphonodectomy was done in 295 women). With respect to clinical outcome, p21waf expression showed a definite favourable trend in both subgroups (N0: p21waf negative, 23 of 87; p21waf positive, nine of 43. N+: p21waf negative, 63 of 107; p21waf positive, 23 of 52), but this observation was not significant (p > 0.05). Multivariate analysis for disease free survival as indicated by Cox regression analysis included all factors investigated. The most striking parameters were nodal status (relative risk (RR), 1.74; p = 0.00001), receptor status (RR, 0.59; p = 0.0085), tumour size (RR, 1.42; p = 0.02), and Her2/neu expression (RR, 1.56; p = 0.033). p21waf expression was not significant in the multivariate analysis (p > 0.05).

Conclusions—p21waf expression is an independent factor but fails to be of prognostic or predictive value in multivariate analysis. These data confirm the hypothesis of a p53 independent p21waf induction and suggest a functional role in the inhibition of PCNA mediated DNA replication.

Key Words: p21waf • proliferating cell nuclear antigen • p53 • breast cancer • immunohistochemistry • prognosis

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Figure 1 Positive p21waf staining in the nuclei of tumour cells in an infiltrating ductal breast cancer (immunoreactive score, 6).
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Figure 2 Kaplan-Meier curves for disease free survival (event = relapse) for (A) node negative (n = 130) and (B) node positive (n = 159) subgroups. Only trends could be observed (log rank test: p > 0.05).

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