Correlation of ER, PR, and HER2 at protein and mRNA levels in the Asian patients with operable breast cancer

Breast cancer is the most common cancer and the leading cause of cancer-related death in women. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are important biomarkers in the prognosis of breast cancer, and their expression is used to categorize breast cancer into subtypes. We aimed to analyze the concordance between ER, PR, and HER2 expression levels and breast cancer subtyping results obtained by immunohistochemistry (IHC, for protein) and reverse transcriptase-polymerase chain reaction (RT-PCR, for mRNA) and to assess the recurrence-free survival (RFS) of the different subtypes as determined by the two methods. We compared biomarker expression by IHC and RT-PCR in 397 operable breast cancer patients and categorized all patients into luminal, HER2, and triple-negative (TN) subtypes. The concordance of biomarker expression between the two methods was 81.6% (kappa = 0.4075) for ER, 87.2% (kappa = 0.5647) for PR, and 79.1% (kappa = 0.2767) for HER2. The kappa statistic was 0.3624 for the resulting luminal, HER2, and TN subtypes. The probability of a 5-year RFS was 0.78 for the luminal subtype versus 0.77 for HER2 and 0.51 for TN, when determined by IHC (p = 0.007); and 0.80, 0.71, and 0.61, respectively, when determined by the RT-PCR method (p = 0.008). Based on the current evidence, subtyping by RT-PCR performs similarly to conventional IHC with regard to the 5-year prognosis. The PCR method may thus provide a complementary means of subtyping when IHC results are ambiguous.

Neoadjuvant Chemotherapy For Stage II–III Breast Cancer: A Single-Center Experience

Introduction: We conducted this study to reflect a single-center experience with the use of neoadjuvant systemic chemotherapy for the management of women with operable breast cancer.Methods: We conducted a retrospective chart review on all women presenting with operable, stage II-III, breast cancer and were scheduled for neoadjuvant systemic chemotherapy at Suez Canal University Hospital. The primary outcome of this study was to estimate the proportion of patients with operable breast cancer who become eligible for breast conservative surgery (CBS) after neoadjuvant systemic chemotherapy.Results: A total of 147 patients were included. Before the initiation of chemotherapy, only 66 (44.9%) patients were indicated for breast conservative surgery (CBS). A total of 40 (50.6%) new patients, out of the 81 patients who were ineligible before chemotherapy, became eligible for breast conservative surgery after neoadjuvant chemotherapy (95% CI 39.3 – 61.9%). On the other hand, nine (13.6%) patients became ineligible for breast conservative surgery after neoadjuvant chemotherapy. Out of the 98 eligible patients for breast conservative surgery after chemotherapy, 72 (73.5%) patients underwent the surgery and the remaining 26 patients chose total modified radical mastectomy (MRM). A total of 55 (76.4%) patients achieved pathological complete response pCR. One woman (0.1%) experienced relapse at the 3rd year of follow-up and three women (2%) experienced relapse at the 5th year of follow-up. The difference between patients who underwent breast conservative surgery and total mastectomy was not statistically significant (p =0.22 and 0.07, respectively).Conclusion: Neoadjuvant chemotherapy can play a crucial role in increasing the rate of eligibility for breast conservative surgery among women with operable, stage II-III, breast cancer.

A Novel Systematic Oxidative Stress Score Predicts the Prognosis of Patients with Operable Breast Cancer

Background. Breast cancer was associated with imbalance between oxidation and antioxidation. Local oxidative stress in tumors is closely related to the occurrence and development of breast cancer. However, the relationship between systematic oxidative stress and breast cancer remains unclear. This study is aimed at exploring the prognostic value of systematic oxidative stress in patients with operable breast cancer. Methods. A total of 1583 operable female breast cancer patients were randomly assigned into the training set and validation set. The relationship between systematic oxidative stress biomarkers and prognosis were analyzed in the training and validation sets. Results. The systematic oxidative stress score (SOS) was established based on five systematic oxidative stress biomarkers including serum creatinine (CRE), serum albumin (ALB), total bilirubin (TBIL), lactate dehydrogenase (LDH), and blood urea nitrogen (BUN). SOS was an independent prognostic factor for operable breast cancer patients. A nomogram based on SOS and clinical characteristics could accurately predict the prognosis of operable breast cancer patients, and the area under the curve (AUC) of the nomogram was 0.823 in the training set and 0.872 in the validation set, which was much higher than the traditional prognostic indicators. Conclusions. SOS is an independent prognostic indicator for operable breast cancer patients. A prediction model based on SOS could accurately predict the outcome of operable breast cancer patients.

PROFILE OF SURROGATE MARKERS OF MOLECULAR SUBTYPES USING THE EXPRESSION PATTERN OF ER, PR, AND HER2/NEU RECEPTORS IN OPERABLE BREAST CANCER

Objective: The present study was planned with an aim to study the profile of surrogate markers of molecular subtypes using the expression pattern of ER, PR, and HER2/NEU receptors in operable breast cancer so that most effective and advantageous treatment can be offered for better surgical outcomes. Methods: A cross-sectional observational study was carried out in one of the tertiary care centers in Central UP. All patients presenting to the center with early and locally advanced breast cancer with age bracket between 18 and 75 years during 2-year period and willing to participate in the study were included in the sample size. Clinical staging was done using the standard TNM criteria and all the specimens were subjected to immunohistochemical evaluation for surrogate molecular subtyping Results: Out of 94 cases enrolled in the study, a total of 32 (34.4%) were identified as luminal A, 3 (3.2%) were identified as luminal B, 35 (37.6%) were identified as HER2 positive, and remaining 23 (24.7%) were identified as triple negative. Statistically, there was no significant difference among groups with respect to age (p=0.958) and BMI (p=0.332). However, there was a significant difference among groups with respect to clinical stage (p=0.031), clinical nodal involvement (p=0.014), pathological staging (p=0.006), and pathological nodal involvement (p=0.023). Among those with nodal involvement, all the cases had involvement of one node except for one patient in Group I who had involvement of thrMost of the luminal A cases (81.3%) were clinically Stage 1 or 2. All the luminal B cases were clinically Stage 2 or 3 (100%). Almost half (48.8%) of Her2-negative cases were Stage 3 or 4. Majority of triple-negative cases were Stage 3 or 4 (65.2%). Clinically, nodal involvement was seen to be maximum in Her2-negative and triple-negative groups (54.3% and 52.2% of cases, respectively). Pathologically, most of the luminal A (83.9%), Her2 negative (81.8%), and all the luminal B cases were Stage 2. Pathologically, nodal involvement was seen in 16.1% of luminal A, 42.4% of Her2-negative, and 50% of triple-negative cases. Conclusion: The findings of the present study provided a glimpse of expression pattern of ER, PR, and HER2/NEU receptors in operable breast cancer based on which most effective and advantageous treatment can be offered for better surgical outcomes.

Effects of Surgery on Prognosis of Young Women With Operable Breast Cancer in Different Marital Statuses: A Population-Based Cohort Study

BackgroundThe influence of surgical approaches [including mastectomy, breast-conserving therapy (BCT) and post-mastectomy breast reconstruction (PMBR) on prognosis of young women (<40 years old) with operable breast cancer has not been determined yet, and this might vary in patients with different marital statuses. Therefore, we aimed to investigate the effect of surgery on survival outcomes for young women with operable breast cancer in different marital statuses.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database to identify young women with operable breast cancer between 2004 and 2016, who underwent mastectomy, BCT or PMBR. We assessed overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan–Meier method and hazard ratios using multivariate Cox proportional hazard regression.ResultsCompared to mastectomy, both of BCT and PMBR conferred better OS (BCT: HR = 0.79, 95%CI: 0.69–0.90, p <0.001; PMBR: HR = 0.70, 95%CI: 0.63–0.78, p <0.001) and BCSS (BCT: HR = 0.79, 95%CI: 0.69–0.91, p = 0.001; PMBR: HR = 0.73, 95%CI: 0.65–0.81, p <0.001), but there was no significant difference of survival between BCT and PMBR group. The survival benefit of BCT compared to mastectomy remained significant in unmarried young women (OS: HR = 0.68, 95%CI: 0.55–0.83, p <0.001; BCSS: HR = 0.69, 95%CI: 0.56–0.86, p = 0.001) but not in the married (OS: HR = 0.89, 95%CI: 0.75–1.05, p = 0.177; BCSS: HR = 0.89, 95%CI: 0.75–1.05, p = 0.161), while no matter married or not, PMBR group had better OS and BCSS than mastectomy group but not BCT group.ConclusionBoth of BCT and PMBR had improved survival compared to mastectomy for young women with operable breast cancer. The survival benefit of BCT compared to mastectomy remained significant in unmarried patients but not in married patients.