Author name:
مصطفى خضير جاسم
Supervisor name:
منور عبد الاله النقاش
Key words:
- Iraqi breast cancer
- molecular classification
- Luminal B like.
Abstract:
Background : Breast cancer is a complex, multifaceted disease encompassing a great variety of entities that show considerable variation in clinical, morphological and molecular attributes. Traditional classifications including histological assessment and clinical staging are used to guide patient management. In recent years, there has been exponential progress in molecular analysis with profound implications for our understanding of breast cancer biology and, hence, classification.Objective : The aim of this study to assess Iraqi breast cancer patients’ clinical profile (tumor size, lymph nodes, etc…). Evaluate patients’ molecular profile (Estrogen receptor, Progesterone receptor, HER2/neu and Ki - 67).Patients & Methods : This is a cross - sectional descriptive study was done in Baghdad oncology teaching hospital from the 1st of December 2015 to the 1st of April 2016, carried on 100 breast cancer female patients with their age range from 27 to 73 years old and with their histopathology reports and immunohistochemical (IHC) results including Estrogen (ER), Progesterone (PgR), HER2/neu and Ki - 67. The patients in this study underwent surgical intervention either by a biopsy or mastectomy with axillary clearance, and the formalin - fixed paraffin - embedded tissue blocks were sent to the hospital’s laboratory for H&E and IHC.Results : The mean age ± SD (51 ± 10) years, the highest incidence of breast cancer among patients in 5th (40 - 49 years) and 6th (50 - 59 years) decades of life and each group is (32%), while the lowest incidence in 3rd decade of life (2%). In regards of tumor size, T1 was (28%), T2 was (56%), T3 was (15%) and T4 was (1%). According to lymph nodes, Nx was (33%), N0 was (16%), N1 was (25%), N2 was (17%) and N3 was (9%). ER and PgR values were observed in 74% and 75% respectively, regarding ER receptor there were 14 patients (14%)XIwith +1, 17 patients (17%) with +2, 43 patients (43%) with +3, and 26 patients (26%) with negative score, while PgR receptor there were 11 patients (11%) with +1, 20 patients (20%) with +2, 44 patients (44%) with +3, and 25 patients (25%) with negative score. In regards of the immunohistochemicetry of Her2/neu there were 26 patients (26%), 28 patients (28%), 30 patients (30%) and 16 patients (16%) for score 0, +1, +2, +3 respectively, score +3 considered positive, score 0, +1 considered negative, while +2 equivocal, and 31 patients (31%) with Ki - 67 <14, while 69 patients (69%) with Ki - 67 ≥14. There was a negative correlation between the tumor size and Her2/neu, with statistically significant P value = 0.013, and there was a weak correlation between the lymph nodes and the tumor size with insignificant P value = 0.181. Also there was a strong correlation between ER and PgR with highly significant P value < 0.0001, and a strong correlation between ER and Her2 with significant P value = 0.009. On the other hand, our results reported a weak correlation between PgR and Her2 with insignificant P value = 0.165. Luminal B - like were 53 patients (53%), Luminal A - like were 29 patients (29%), Triple negative were 15 patients (15%) and HER2 overexpressed were 3 patients (3%). The highest frequency was seen among patients with Luminal B - like followed by Luminal A - like and triple negative, while the lowest frequency was seen among patients with HER2 overexpressed.Conclusions : Highest incidence of breast cancer in the studied patients was seen ≥ 40 years in the 5th & 6th decades of life, and the most common tumor size was T2, beside the most common assessed axillary lymph nodes were N1. Luminal B - like was the most common molecular subtype of the breast cancer patients in the studied group mostly due to high Ki - 67 index. Most of the breast cancer patients in the current study were ER and PgR (Hormonal) positive 74%, 75% respectively
