Mishra Anjali, Mishra Shravan Kumar, Sharanappa Vikram, Krishnani Narendra, Kumari Niraj, Agarwal Gaurav
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014 India.
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014 India.
Indian J Surg Oncol. 2024 Jun;15(2):250-257. doi: 10.1007/s13193-024-01877-2. Epub 2024 Jan 15.
Molecular sub-characterization of triple-negative breast cancer (TNBC) has great therapeutic and possibly prognostic implications. The primary aim of this study was to investigate the incidence of luminal androgen receptor (LAR) subtype of TNBC and secondary aims were sub-categorization and clinico-pathologic correlation of LAR breast cancers. Retrospective study () consisting of 157 TNBC patients. Androgen receptor (AR) expression was measured by immunohistochemical analysis. One percent cutoff was set as a positive expression. Sub-categorization was done on the basis of EGFR (> 15% of tumor cells) and Ki-67 expression (low- < 11%, intermediate- 11-20%, and high- > 21%). AR expression was correlated with various clinico-pathologic features and outcomes of the patients. The incidence of AR expression in TNBC was 24.8%. Considering different thresholds of > 5%, > 10%, and > 20% immunostaining, the incidence of AR positivity was 18.4, 15.2, and 11.5% respectively. The incidence of Ki-67 ( = 0.89) and EGFR ( = 0.643) expression did not differ significantly in AR-positive and -negative TNBC. Based on EGFR expression 19, 67 and 14% patients were categorized as low, intermediate, and high risk respectively. Low-risk ( ≤ 0.001) and low-grade ( = 0.014) tumors were more likely to have > 10% AR expression. Clinico-pathological profile, response to neoadjuvant chemotherapy, disease-free survival ( = 0.458), and overall survival ( = 0.806) did not significantly differ between AR expressing and negative TNBC. On multivariate analysis, only tumor staging was a significant predictor of survival ( = 0.012) and AR expression of > 10% revealed a trend towards improved survival ( = 0.07). When considering only AR-positive TNBC, AR expression of > 10% ( = 0.038), distant metastases ( = 0.003), and EGFR status ( = 0.024) were significantly associated with survival. AR expression does not seem to very strongly correlate with prognosis in TNBC and further studies could focus more on its predictive role in deciding anti-androgen therapy.
三阴性乳腺癌(TNBC)的分子亚特征具有重要的治疗意义,可能还具有预后意义。本研究的主要目的是调查TNBC中腔面雄激素受体(LAR)亚型的发生率,次要目的是对LAR乳腺癌进行亚分类并分析其临床病理相关性。对157例TNBC患者进行回顾性研究。通过免疫组织化学分析检测雄激素受体(AR)的表达。将1%的截断值设定为阳性表达。根据表皮生长因子受体(EGFR,>15%的肿瘤细胞)和Ki-67表达(低表达<11%、中等表达11%-20%、高表达>21%)进行亚分类。AR表达与患者的各种临床病理特征及预后相关。TNBC中AR表达的发生率为24.8%。考虑免疫染色>5%、>10%和>20%的不同阈值时,AR阳性的发生率分别为18.4%、15.2%和11.5%。AR阳性和阴性的TNBC中,Ki-67(=0.89)和EGFR(=0.643)表达的发生率无显著差异。根据EGFR表达情况,分别有19%、67%和14%的患者被分类为低风险、中等风险和高风险。低风险(≤0.001)和低级别(=0.014)肿瘤更有可能有>10%的AR表达。AR表达阳性和阴性的TNBC在临床病理特征、对新辅助化疗的反应、无病生存期(=0.458)和总生存期(=0.806)方面无显著差异。多因素分析显示,只有肿瘤分期是生存的显著预测因素(=0.012),而AR表达>10%显示出生存改善的趋势(=0.07)。仅考虑AR阳性的TNBC时,AR表达>10%(=0.038)、远处转移(=0.003)和EGFR状态(=0.024)与生存显著相关。AR表达似乎与TNBC的预后相关性不强,进一步的研究可以更多地关注其在决定抗雄激素治疗中的预测作用。