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Heterogeneity in the Clinical Phenotype of TP53 Mutations in Breast Cancer Patients¹

Danish Cancer Society, Department of Experimental Clinical Oncology, Aarhus University Hospital, DK-8000 Aarhus C [J. A., J. O.]; Department of Tumour Cell Biology, Institute of Cancer Biology, DK-2100 Copenhagen Ø [P. G.]; and Departments of Oncology [M. Y.] and Human Genetics [L. L. H.], Aarhus University Hospital, DK-8000 Aarhus C, Denmark

TP53 mutation is a strong independent marker for survival in breast cancer with some heterogeneity in the clinical phenotype of various types of mutations. Based on 315 patients with breast carcinoma, we suggest a new model for the differentiation of TP53 mutations. Although TP53 mutation in general was associated with aggressive tumor/patient characteristics, missense mutations outside any conserved or structural domain did not affect the clinical outcome (risk of disseminated disease and death). In contrast, patients with missense mutations affecting amino acids directly involved in DNA or zinc binding displayed a very aggressive clinical phenotype. Null mutations (including missense mutations disrupting the tetramerization domain) and the remaining missense mutations displayed an intermediate aggressive clinical phenotype. When patients with primary early breast cancer were divided into three groups (wild-type together with missense mutations outside structural/conserved domains, null mutations and missense mutations with intermediate clinical phenotype, and very aggressive missense mutations), disease-specific survival rates were 89%, 58%, and 35% (5-year actuarial values, P < 0.0001), respectively. In a Cox proportional hazards analysis, separation of TP53 mutations according to these criteria eliminated the prognostic importance of all investigated classical factors except nodal status.

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