Alwan Nada A S, Mualla Faisal H, Al Naqash Munawar, Kathum Saad, Tawfiq Furat N, Nadhir Sana
Director, National Cancer Research Center, Iraq; Professor, Baghdad University.
Public Health, Queen Mary Hospital, UK.
Gulf J Oncolog. 2017 Sep;1(25):51-60.
Breast cancer is the most common malignancy affecting the Iraqi population and the leading cause of cancer related mortality among Iraqi women. It has been well documented that prognosis of patients depends largely upon the hormone receptor contents and HER-2 over expression of their neoplasm. Recent studies suggest that Triple Positive (TP) tumors, bearing the three markers, tend to exhibit a relatively favorable clinical behavior in which overtreatment is not recommended.
To document the different frequencies of ER/PR/HER2 breast cancer molecular subtypes focusing on the Triple Positive pattern; correlating those with the corresponding clinico-pathological characteristics among a sample of Iraqi patients diagnosed with the disease.
This retrospective study involved 570 female patients diagnosed with breast cancer who visited the Main Referral Center for Early Detection of Breast Cancer and the National Cancer Research Center. The requested data was mainly extracted from an established information system database, developed by the principal author over a 4-years period from 2012 to 2016. The registered information comprised data related to clinical presentation, diagnostic and pathologic findings. ER, PR and HER2 status were analyzed immunohistochemically and the detected profiles were correlated with the corresponding clinico-pathological characteristics.
The rates of ER (+), PR (+) and HER-2 (+) tumors were 66.8%, 64% and 29.3% respectively. The tumor marker expression status was documented in eight subtypes; 83 cases (14.6%) of the examined breast carcinomas were categorized as ER+/PR+/HER2+ (Triple Positive/Luminal B), 89 cases (15.6%) were ER-/PR-/HER2- (Triple Negative), 241 (42.2%) were ER+/PR-/HER2- (Luminal A) while 67 (11.8%) showed ER-/PR-/HER2+ expression (HER-2 variant). No significant variations were noted when comparing age, menopausal status and tumor grade of Luminal B pattern to Luminal A and the rest of the studied subtypes. Although our data revealed a statistical difference with respect to the distribution of tumor types; where infiltrative ductal carcinoma constituted the major histology among patients with Triple Positive/Luminal B subtype (86.7% as compared to 67.6% in Luminal A), nevertheless, more than two third of those patients (67.4%) were diagnosed at earlier stages (I and II) compared to 55.2% of those in the remaining groups.
Our findings support the hypothesis that the Triple Positive subtype might be driven primarily by the hormone receptor status. Further comprehensive surveys are recommended to focus on the intrinsic interactions and tumor cell heterogeneity of that pattern to avoid overtreatment and predict accurate response to therapy.
乳腺癌是影响伊拉克人群的最常见恶性肿瘤，也是伊拉克女性癌症相关死亡的主要原因。已有充分文献证明，患者的预后在很大程度上取决于其肿瘤的激素受体含量和HER-2过表达情况。最近的研究表明，携带这三种标志物的三阳性（TP）肿瘤往往表现出相对良好的临床行为，不建议过度治疗。
记录ER/PR/HER2乳腺癌分子亚型的不同频率，重点关注三阳性模式；并将其与诊断为该疾病的伊拉克患者样本中的相应临床病理特征相关联。
这项回顾性研究纳入了570名诊断为乳腺癌的女性患者，她们就诊于乳腺癌早期检测主要转诊中心和国家癌症研究中心。所需数据主要从一个既定的信息系统数据库中提取，该数据库由第一作者在2012年至2016年的4年期间开发。登记的信息包括与临床表现、诊断和病理结果相关的数据。通过免疫组织化学分析ER、PR和HER2状态，并将检测到的特征与相应的临床病理特征相关联。
ER（+）、PR（+）和HER-2（+）肿瘤的发生率分别为66.8%、64%和29.3%。肿瘤标志物表达状态记录为八种亚型；在所检查的乳腺癌中，83例（14.6%）被归类为ER+/PR+/HER2+（三阳性/管腔B型），89例（15.6%）为ER-/PR-/HER2-（三阴性），241例（42.2%）为ER+/PR-/HER2-（管腔A型），而67例（11.8%）表现为ER-/PR+/HER2+表达（HER-2变异型）。将管腔B型与管腔A型及其他研究亚型的年龄、绝经状态和肿瘤分级进行比较时，未发现显著差异。尽管我们的数据显示肿瘤类型分布存在统计学差异；浸润性导管癌是三阳性/管腔B亚型患者中的主要组织学类型（86.7%，而管腔A型为67.6%），然而与其余组中的55.2%相比这些患者中超过三分之二（67.4%）在早期阶段（I期和II期）被诊断出来。
我们的研究结果支持以下假设，即三阳性亚型可能主要由激素受体状态驱动。建议进一步进行全面调查，重点关注该模式的内在相互作用和肿瘤细胞异质性以避免过度治疗并预测对治疗的准确反应。
