The Potential of Plasminogen Activator Inhibitor-1 as Prognostic Factor of Advanced Breast Cancer

Abstract

Background: Advanced breast cancer causes problems in morbidity, mortality, quality of life, and low survival rate. Hence, a biomarker to predict the progression of cancer is needed. Plasminogen activator inhibitor-1 (PAI-1) has been known as one of the prognostic factors. However, in vivo studies indicated that PAI-1 has controversial roles. Whether PAI-1 suppresses or promotes the development of cancer, is still being the question. The study aims to examine the role of PAI-1 in predicting the survival rate and its association with clinicopathologic factors in advanced breast cancer. Materials and Methods: The historical cohort analytic method in advanced breast cancer patients was conducted at Dharmais National Cancer Center Hospital. Clinical data were obtained from patients’ medical records. The expression of PAI-1 was assessed through immunohistochemistry assay staining of breast cancer tissue using antibody PAI-1 Santa Cruz Biotechnology, Inc., PAI-1 C-9 sc5297. Survival analysis was done to obtain the prognostic data. Moreover, its association with clinicopathologic factors was analyzed. Results: Fifty-eight subjects were included in this study. There was a significant association between the expression of PAI-1 and survival rate (hazard ratio [HR] = 4.08, 95% confidence interval [CI] = 1.75 - 9.50, p = 0.001). The Kaplan-Meier method indicated significant differences in survival rate between subjects with high expression of PAI1 and those with low expression in advanced breast cancer (p = 0.001). PAI-1 expression had a sensitivity of 84.7% and specificity of 60% based on immunohistochemical score cut off of 90. Furthermore, the expression of PAI-1 showed no significant association with clinicopathological factors except for histopathology grade. (Relative risk [RR] = 1.5, 95%, CI = 1.2 - 1.8, p = 0.047). Conclusion: Advanced breast cancer patients with high expression of PAI-1 have better survival. PAI-1 expression is not associated with clinicopathological factors, except for the histopathological grade.