The Effect of P-Glycoprotein (P-gp), Nuclear Factor-Kappa B (Nf-κb), and Aldehyde Dehydrogenase-1 (ALDH-1) Expression on Metastases, Recurrence and Survival in Advanced Breast Cancer Patients

Document Type : Research Articles


Department of Oncologic Surgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.


Objective: To investigate the level of three drug resistance proteins; P-glycoprotein 1 (P-gp), nuclear factor
kappa-light-chain-enhancer of activated B cells (NF-κB) and aldehyde dehydrogenase isoform 1 (ALDH1) expression
and their relationship to metastasis, recurrence and survival in advanced breast cancer patients that received neoadjuvant
chemotherapy. Methods: This study is a combination of prospective and retrospective cohort study involving one
hundred and thirty one cases of advanced stage invasive breast cancer that have received neoadjuvant chemotherapy.
Initial biopsy specimens (incisional biopsy or core biopsy) were taken from paraffin blocks. Immunohistochemistry
(IHC) was used to detect P-gp, NF-κB, and ALDH1 expression. Prospectively analysed patients were followed for five
years and evaluated for recurrence and death. Results: The expression of P-gp has no significant statistical correlation
to metastases (p = 0.659), recurrence (p = 0.862) and survival (p = 0.835) in advanced stage breast cancer patients
who received neoadjuvant chemotherapy. Similarly, ALDH1 was not correlated to metastases (p=0.120), recurrence
(p = 0.186) and survival (p = 0.254) statistically. We found that NF-κB expression showed a significant correlation to
metastases (p=0.004), recurrence (p = 0.016) and overall survival (p = 0.041) in advanced stage breast cancer patients
after neoadjuvant chemotherapy. Conclusion: NF-κB expression is a potential marker that can be used to assess or
to predict increasing risk of metastases, recurrence and survival in advanced stage breast cancer patients who receive
neoadjuvant chemotherapy.


Main Subjects