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Background  Prognostic factors in patients who are diagnosed with T4 breast carcinomas are widely awaited. We here evaluated the clinical role of some molecular alterations involved in tumorigenesis in a well-characterized cohort of T4 breast cancer patients with a long follow-up period.    Methods  A consecutive series of 53 patients with T4 breast carcinoma was enrolled between 1992 and 2001 in Sardinia, and observed up for a median of 125 months. Archival paraffin-embedded tissue sections were used for immunohistochemistry (IHC) and fluorescence  in situ  hybridization (FISH) analyses, in order to assess alterations in expression levels of survivin, p53, and pERK 1-2  proteins as well as in amplification of  CyclinD1  and  h-prune  genes. The Kaplan-Meier and Cox regression methods were used for survival assessment and statistical analysis.    Results  Overall, patients carrying increased expression of pERK 1-2  (p = 0.027) and survivin (p = 0.008) proteins as well as amplification of  h-prune  gene (p = 0.045) presented a statistically-significant poorer overall survival in comparison with cases found negative for such alterations. After multivariate analysis, the pathological response to primary chemotherapy and the survivin overexpression in primary carcinoma represented the main parameters with a role as independent prognostic factors in our series.    Conclusions  Although retrospective, our study identified some molecular parameters with a significant impact on prediction of the response to therapy or prognosis among T4 breast cancer patients. Further large prospective studies are needed in order to validate the use of such markers for the management of these patients.

Molecular alterations in key-regulator genes among patients with T4 breast carcinoma