Plasma plasminogen activator inhibitor-1 (PAI-1) levels in breast cancer - relationship with clinical outcome.

BACKGROUND Signaling pathways triggered by increased thrombin or plasminogen activator inhibitor-1 (PAI-1) expression drastically alter the tumor microenvironment, contributing to an adverse outcome. This study aimed to evaluate the prognostic value of coagulation/fibrinolytic activities in breast cancer (BC). MATERIALS AND METHODS Coagulation/fibrinolytic activities were investigated in 187 patients with breast cancer, with respect to possible associations with clinicopathological features and survival outcomes. RESULTS Levels of plasma PAI-1 (p<0.001), D-dimer (p=0.037) and activated protein C-dependent thrombin generation (p=0.003) were higher in women with breast cancer compared to 187 healthy women. PAI-1 directly correlated with D-dimer levels (p=0.009) and Ki67 expression (p=0.027), which were both predictors of elevated PAI-1 levels at multivariate regression analysis. Cox analysis demonstrated that an elevated plasma PAI-1 level had a negative prognostic impact in terms of relapse-free (hazard ratio=2.5, p=0.021) and overall survival (hazard ratio=2.7, p=0.002). CONCLUSION Determination of plasma PAI-1 levels might provide important prognostic information in risk stratification and survival outcomes for patients with breast cancer.