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Category: Volume 05 Issue 10 October 2017
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Title: The Prognostic Value of Luminal Subtypes of Breast Cancer and their Impact on the Patient's Outcome

Authors: Ahmed Abdel-Latif Abdel Kader, Tarek Abdel Halim El Fayoumi, Mohammed Ahmed El-Sayed Saqr, Ahmed Tarek Fouad Awad

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.25

Abstract

Background: Breast cancer is the major cause of death by cancer among females in developing countries. Although the overall breast cancer incidence rate in the developed countries is double that seen in developing countries, the mortality rates from the disease are generally similar. However, survival following breast cancer tends to be poorer in developing countries, this is attributed to late diagnosis and limited access to standard treatment. One of the challenges in treating the disease is addressing the biological heterogeneity evident in the presence of several histologic and molecular subtypes.(1-4)

Despite advances, about 20% to 30% of patients with early breast cancers will experience distantmetastatic relapse. (5) Risk of recurrence is inhanced by the stage at initial presentation and the underlying molecular biology of the tumor. Nodal ,Tumor size, , grade, lympho-vascular and perineural invasion, and estrogen receptor (ER) (6) and human epidermal growth factor receptor 2 (HER2) (7) status are all major risk factors for relapse.

The response of breast cancer patients to hormonal therapy is currently guided by the expression of two steroid hormonal receptors (HR): estrogen receptor-α (ER-α), progesterone receptor (PR) and proliferation marker Ki-67. Expression of PR, in fact, has been reported to confer good prognosis to breast cancer patients.(8) Another molecular marker that is increasingly being examined in breast cancer for therapeutic potential as well as a prognostic indicator is the human epidermal growth factor receptor type 2 (Her-2/neu) oncoprotein.(9-11) Although several subtype classifications have been developed, the different classifications generally agree on four subtypes (luminal A, luminal B, HER2-enriched and basal-like).(12)

Aim of the study: The aim of this study is to assess the hormonal receptors and molecular subtypes for their impact on management in breast cancer patients.

Patients:This study was carried out retrospectively on 400 patients presented to Surgical oncology unit; Alexandria Main University Hospital, Medical and Surgical Oncology units; Gamal Abdel-Nasser Health Insurance Hos-pital was obtained within 3 years from January 2010 to January 2013.

Subjects and Methods: The patients data were collectedfromSurgical oncology unit; Alexandria Main University Hospital, Medical and Surgical Oncology units; Gamal Abdel-Nasser Health Insurance Hos-pital within 3 years from January 2010 to January 2013 and filtered into flow sheets.

Results: The age was varying between 32.0 - 86.0 years with a mean age of 55.27 ± 9.24 years.Luminal A subtype was found to be the most frequent type presenting 74.3% of patients followed by Luminal B (12.3%), Triple –ve (10.5%) and Her2 type, the least common, presenting 3.0% of patients. Infiltrating duct carcinoma (NOS) (IDC) was the most commonly diagnosed histopathological type presenting 93.8% of cases.There was no history of recurrence of the primary tumor in 80.3% of cases, 8.7% of cases presented with loco-regional recurrence (LRR) and 11.0% of cases presented with distant recurrence within four years after excision of the primary tumor. The Triple –ve group had the highest incidence of recurrence with 48.0% and 16.0% of cases with loco-regional recurrence and distant recurrence respectively, followed by Luminal B and Luminal A subtypes. Her2-enriched subtype showed no distant recurrence among the group patients.

Conclusion: Luminal A subtype is the most frequent biological subtype and Her2 type is the least common. Triple –ve group has the highest incidence of recurrence with 48.0% and 16.0% of cases with loco-regional recurrence and distant recurrence respectively, followed by Luminal A and B subtypes and Her2 enriched subtype showed no distant recurrence among the group patients.

 

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Corresponding Author

Mohammed Ahmed El-Sayed Saqr

Department of surgery, Faculty of Medicine, University of Alexandria