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Although ApoD has been reported to be a marker of breast cancer, its prognostic importance in invasive breast cancer is unclear. The aim of this study was to investigate the relationship between ApoD protein expression, oestrogen receptor\u2010\u03b1 (ER\u03b1) expression and androgen receptor (AR) expression in predicting breast cancer outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>ApoD levels were measured by the use of immunohistochemistry and video image analysis on tissue sections from a breast cancer cohort (<jats:italic>n<\/jats:italic>\u00a0=\u00a0214). We assessed the associations of ApoD expression with disease\u2010free survival (DFS), metastasis\u2010free survival (MFS), and overall survival (OS). We also assessed the relationship between ApoD expression, AR expression and ER\u03b1 expression in predicting OS. ApoD expression (&gt;1% ApoD positivity) was found in 72% (154\/214) of tissues. High ApoD positivity (\u226520.7%, fourth quartile) was an independent predictor of MFS and OS, and conferred a 2.2\u2010fold increased risk of developing metastatic disease and a 2.1\u2010fold increased risk of breast cancer\u2010related death. ApoD positivity was not associated with AR or ER\u03b1 nuclear positivity. However, patients with (\u22651%) ER\u03b1\u2010positive cancers with low (&lt;20.7%) ApoD positivity, or those showing high (\u226578%) AR positivity and low (&lt;20.7%) ApoD positivity had better OS than other patient groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ApoD expression could be used to predict breast cancer prognosis independently of ER\u03b1 and AR expression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.14081","type":"journal-article","created":{"date-parts":[[2020,1,29]],"date-time":"2020-01-29T05:11:37Z","timestamp":1580274697000},"page":"976-987","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Elevated levels of tumour apolipoprotein D independently predict poor outcome in breast cancer patients"],"prefix":"10.1111","volume":"76","author":[{"given":"Tanja","family":"Jankovic\u2010Karasoulos","sequence":"first","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"},{"name":"Adelaide Medical School Robinson Research Institute Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8431-5338","authenticated-orcid":false,"given":"Tina","family":"Bianco\u2010Miotto","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"},{"name":"Adelaide Medical School Robinson Research Institute Adelaide South Australia Australia"},{"name":"Waite Research Institute School of Agriculture, Food and Wine University of Adelaide Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam S","family":"Butler","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M","family":"Butler","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"},{"name":"Prostate Cancer Research Group South Australian Health and Medical Research Institute Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catriona M","family":"McNeil","sequence":"additional","affiliation":[{"name":"Cancer Research Program Garvan Institute of Medical Research Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra A","family":"O\u2019Toole","sequence":"additional","affiliation":[{"name":"Cancer Research Program Garvan Institute of Medical Research Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewan K A","family":"Millar","sequence":"additional","affiliation":[{"name":"Cancer Research Program Garvan Institute of Medical Research Sydney New South Wales Australia"},{"name":"NSW Health Pathology St George Hospital Kogarah New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J","family":"Sakko","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra I","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen N","family":"Birrell","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L","family":"Sutherland","sequence":"additional","affiliation":[{"name":"Cancer Research Program Garvan Institute of Medical Research Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa E","family":"Hickey","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne D","family":"Tilley","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer Research Laboratories Adelaide Medical School Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7415-1854","authenticated-orcid":false,"given":"Carmela","family":"Ricciardelli","sequence":"additional","affiliation":[{"name":"Dame Roma Mitchell Cancer 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