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Purpose . We aimed to investigate the expression of pentose phosphate pathway- (PPP-) related proteins in metastatic breast cancer and its relationship with clinicopathologic factors.  Methods . Tissue samples from 126 metastatic breast cancers were included in a tissue microarray. Expression of PPP-related proteins [glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconolactonase (6PGL), 6-phosphogluconate dehydrogenase (6PGDH), and nuclear factor erythroid 2-related factor (NRF2)] was determined by immunohistochemistry.  Results . G6PDH ( p  = 0.011) and cytoplasmic NRF2 ( p  = 0.001) showed the highest expression in brain metastases. Human epidermal growth factor receptor (HER-2) positivity was associated with G6PDH ( p  < 0.001) and cytoplasmic NRF2 ( p  = 0.015) positivity. A high Ki-67 labeling index (LI) was correlated with nuclear NRF2 positivity ( p  = 0.037), and HER-2-positive luminal B type was associated with G6PDH positivity ( p  = 0.001). On multivariate Cox analysis, independent risk factors of short overall survival were 6PGL positivity in bone metastasis (HR 4.180, 95% CI 1.160–15.06,  p  = 0.029) and low Ki-67 LI in lung metastasis (HR 11.853, 95% CI 1.841–76.30,  p  = 0.009).  Conclusion . Differential expression of PPP-related proteins correlated with different prognoses and metastatic sites, with the highest expression in brain metastases, and could be a potential therapeutic target.

Differential Site-Based Expression of Pentose Phosphate Pathway-Related Proteins among Breast Cancer Metastases