Predictive value of podoplanin and alpha-smooth muscle actin expression levels for the efficacy and prognosis of neoadjuvant chemotherapy in breast cancer
YE Jiahui
GUO Xiaoling
LUO Miao
JIAO Jinlan
LYU Yinhua
WEI Wenqian
ZHANG Weijie
Abstract：Objective To investigate the predictive value of cancer-associated fibroblast markers podoplanin(PDPN)and alpha-smooth muscle actin(α-SMA)in evaluating the efficacy and predicting prognosis of breast cancer patients receiving neoadjuvant chemotherapy(NACT).Methods Clinicopathological data were collected from 80 breast cancer patients who underwent NACT followed by surgical resection at Nanjing Drum Tower Hospital between January 2010 and December 2015.Expression of PDPN andα-SMA in tumor tissues was detected by immunohistochemistry and assessed using a semi-quantitative histochemical score(H-score).Based on the mean H-score,patients were categorized into high-and low-expression groups.The associations between PDPN/α-SMA expression and clinicopathological features,NACT efficacy(evaluated using the Miller-Payne pathological grading system),and prognosis were analyzed.Relationships between marker expression and clinicopathological parameters were examined using x2 test or Fisher's exact test.Overall survival(OS)served as the primary prognostic endpoint.Kaplan-Meier curves were plotted,and differences between groups were compared using the Log-rank test.A multivariate Cox proportional hazards regression model was applied to determine independent prognostic factors.Receiver operating characteristic(ROC)curve analysis was used to assess the predictive efficacy of PDPN and α-SMA expression for patient prognosis.Results The H-scores for PDPN and α-SMA in the 80 breast cancer tissues were 73.63±59.04 and 66.50±54.62,respectively.Among the patients,41 had low PDPN expression and 39 had high expression,while 44 had low α-SMA expression and 36 had high expression.Correlation analysis revealed that high expression of both PDPN(x2=8.605,P=0.003)and α-SMA(x2=21.721,P＜0.001)was significantly associated with more advanced lymph node metastasis,but not with NACT efficacy(both P＞0.05).Survival analysis showed that the OS of the high PDPN expression group was significantly lower than that of the low expression group(Log-rank x2=16.945,P＜0.001),and a similar trend was observed for α-SMA(Log-rank x2=11.634,P=0.001).Multivariate Cox analysis further confirmed that PDPN(adjusted HR=1.066,95％CI:1.024-1.110,P=0.002)and α-SMA(adjusted HR=1.034,95％CI:1.001-1.068,P=0.041)were independent risk factors affecting OS.ROC curve analysis indicated that the combined area under the curve for predicting patient prognosis using both markers was 0.784(95％CI:0.664-0.904,P=0.003),which was superior to either marker alone.Conclusion High expression of PDPN and α-SMA in breast cancer patients is significantly associated with lymph node metastasis and poor prognosis following NACT.Combined detection of these markers offers enhanced prognostic value and may serve as a potential clinical evaluation indicator.
Keywords：breast cancerneoadjuvant chemotherapypodoplaninalpha-smooth muscle actinefficacy evaluationprognostic prediction
Publication Date：2026-01-28
Online Publishing Date：2026-03-18(First online date of this platform, not the publication date of the document)
Pages：6( 67-72 )