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Breast Cancer Res Treat. 2019 Feb;174(1):93-102. doi: 10.1007/s10549-018-5063-9. Epub 2018 Nov 24.

Connexin 43 is an independent predictor of patient outcome in breast cancer patients.

Author information

1
Cancer Immunology Group, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.
2
Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.
3
Department of Pathology, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK.
4
Host-tumour interactions Group, Division of Cancer and Stem cells, School of Medicine, University of Nottingham, Nottingham, UK.
5
Cancer Immunology Group, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK. Judith.ramage@nottingham.ac.uk.
6
Academic Unit of Clinical Oncology, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, UK. Judith.ramage@nottingham.ac.uk.

Abstract

PURPOSE:

Gap junctions are specialized membrane structures that form channels between adjacent cells allowing cell communication. Gap junctions and specifically Connexin 43 (Cx43) are down-regulated in cancer; however, there are contrasting reports on how this effects breast cancer patient survival. This paper is the first large-scale tissue microarray analysis of Cx43 expression in breast cancer patients with an associated clinical long-term follow-up.

METHODS:

Using a validated TMA of 1118 primary breast cancers, coupled to a comprehensive database of clinicopathological variables, the expression levels and subcellular localisation of Cx43 was assessed by immunohistochemistry. Its impact in terms of survival, distant metastasis-free survival, and clinicopathological variables was determined.

RESULTS:

Patients whose tumors expressed high levels of Cx43 had significantly better survival (p < 0.001) than patients with low levels. High Cx43 expression within tumors was associated with an 18-month survival advantage. Loss of Cx43 expression was associated with markers of poor prognosis, namely large tumor size, high grade, high proliferation status, high pleomorphism, high mitosis, poor Nottingham Prognostic Index (NPI), and triple negative tumors. Cx43 expression was independent of tumor size, grade, stage and ER-status in predicting poor survival on multivariate analysis (p = 0.004).

CONCLUSION:

Connexin 43 (Cx43) is an independent predictor of breast cancer survival and distant metastasis-free survival. High expression of Cx43 was seen in only 13% of tumors, suggesting that drugs to increase Cx43 expression may result in prolonged patients survival.

KEYWORDS:

Connexin 43; Tissue microarray; Tumor biomarker

PMID:
30474779
PMCID:
PMC6418069
DOI:
10.1007/s10549-018-5063-9
[Indexed for MEDLINE]
Free PMC Article

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