| Background & Objective: Breast cancer is the most common malignant tumor in women nowadays,with an annual incidence of about 304,000 cases in China.Triple-negative breast cancer(TNBC)accounts for about 10%-15% of all breast cancers,but its recurrence rate and mortality are higher than that of other molecular subtypes,and there is a lack of specific treatment means.Therefore,finding new therapeutic targets for TNBC has become a hot research topic and a demand for clinical practice in breast cancer.Podoplanin(PDPN)is a transmembrane glycoprotein that has been used as a marker of lymphatic endothelium.Podoplanin is expressed in a variety of malignant tumor cells and cancer-associated fibroblasts(CAFs)and interacts with tumor microenvironment to promote tumor progression and affect patient prognosis.Some studies have shown that the expression of PDPN may significantly increase in TNBC tumor tissues,and the influence of PDPN on the clinical characteristics and prognosis of TNBC needs to be further revealed,so as to provide guidance for the search of new therapeutic targets.Methods: 111 patients with invasive ductal breast carcinoma admitted in Northern Jiangsu People’s Hospital from August 1,2012 to July 31,2015 who was operated with mastectomy,was involved in this research.We collected clinical data including the patients age,whether postoperative systemic chemotherapy,whether postoperative radiotherapy,postoperative chemotherapy regimens,preoperative blood platelet count within a week,pathological index(including tumor size,HER-2 status,histological grade,presence of vascular invasion,the number of lymph nodes with metastasis and level of Ki67,TNM staging,etc.).The patients were followed up for 5-8 years,and the relevant indicators included survival,distant metastasis,metastatic site,overall survival(OS),disease-free survival(DFS),etc.After surgical resection of the specimens of patients were collected,the specimen sections were subjected to fluorescence immunolabeling test,and the patients were grouped according to the expression of PDPN and the expression sites.The differences in various indicators among the groups were compared,and the survival analysis was conducted.Results:PDPN was positively expressed in TNBC tissues in 77 cases,accounting for69.4% of the total.Among them,PDPN was expressed in CAFs in 65 cases,accounting for 58.6% of the total.41 patients expressed PDPN in tumor cells,accounting for 36.9%of the total.Univariate analysis showed that compared with the PDPN negative group,patients receiving postoperative radiotherapy was higher in the PDPN positive group,and tumor size,the number of patients with high Ki67 expression rate,N stage,number of lymph nodes with metastasis was significantly higher than that in the negative group(P<0.05).According to PDPN and expressed in tumor cells expressed in CAF or not,the case can be divided into four groups: positive CAFs and positive tumor cells group(Group 1,29 cases,26.1%),positive CAFs but negative tumor cells group(Group 2,35 cases,32.4%),negative CAFs but positive tumor cells group(Group 3,12 cases,10.8%)and CAFs along with tumor cells both negative group(Group 4,34 cases,30.63%).The maximum diameter of the median tumor was larger in the two groups with positive CAFs(Group 1 and 2)than Group 4(3.0cm vs 3.0cm vs 2.0cm,P=0.001).Compared with Group 3,the T stage and N stage of Group 1 and Group 2 were higher,and the maximum diameter of tumor was larger.In terms of survival analysis,the survival rates of the four groups during the follow-up period were 48.3%,61.1%,3.3% and 82.4%,respectively(P=0.017).The disease-free survival rates were 41.4%,55.6%,66.7% and 67.6%(P=0.176),respectively.Multivariate analysis showed that positive PDPN in CAF was an independent risk factor for overall survival of patients with TNBC(HR=3.118,P=0.006,95%CI: 1.380-7.045),while positive PDPN in CAF was also an independent risk factor for recurrence and metastasis of TNBC(HR=2.258,P=0.015,95%CI: 1.173-4.344).Conclusion:(1)Among TNBC patients,PDPN was expressed in tumor tissues in about69.4% of patients(77 out of 111),PDPN was expressed in CAF in 58.6% of patients(65out of 111),and PDPN was expressed in tumor cells in 36.9% of patients(41 out of 111).(2)TNBC patients expressing PDPN in tumor tissue had larger tumor maximum diameter,higher N stage,and more cases with high expression of Ki67.Among them,the patients with PDPN expression in CAF had poor pathological characteristics,overall survival and disease-free survival.(3)PDPN expression in CAF is an independent risk factor for death,recurrence and metastasis in TNBC patients.(4)PDPN expression in TNBC tumor cells had no significant effect on the pathological characteristics and survival of the patients. |
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