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Disease Markers
Volume 35 (2013), Issue 5, Pages 337–344
Research Article

Nuclear Expression of Snail Is an Independent Negative Prognostic Factor in Human Breast Cancer

1Institute of Pathology, University Hospital Basel, Schoenbeinstraße 40, 4031 Basel, Switzerland
2Department of Surgery, University Hospital Basel, Spitalstraße 21, 4031 Basel, Switzerland
3Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
4Department of Surgery, Hospital Center Biel, Vogelsang 84, 2502 Biel, Switzerland

Received 23 March 2013; Revised 13 June 2013; Accepted 5 July 2013

Academic Editor: Gad Rennert

Copyright © 2013 S. Muenst et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Snail is a key regulator of epithelial-mesenchymal transition of tumor cells. Several studies have shown nuclear Snail expression to be a negative prognostic factor in human cancer, where it is generally associated with more aggressive tumor behavior and worse survival. Objectives and Methods. To further explore the role of Snail expression in breast cancer, we conducted a study on a tissue microarray, encompassing 1043 breast cancer cases. Results. A total of 265 (25.4%) breast cancers were positive for Snail. Snail expression was significantly associated with greater tumor size, higher tumor stage and grade, positive lymph node status, and hormone receptor negative status and was differently expressed in the intrinsic subtypes of breast cancer, being the highest in the basal-like subtype and the lowest in the luminal A subtype. In multivariate analysis, Snail proved to be an independent negative prognostic factor for OS. In the intrinsic subtypes, Snail expression was a negative prognostic factor for OS in the luminal B HER2, the luminal B HER2+, and the basal-like subtype. Conclusions. This is the first study demonstrating that nuclear Snail expression is an independent negative predictor of prognosis in breast cancer, thus suggesting that it may represent a potential therapeutic target.