Trends in Molecular Classification of Breast Carcinoma in a Tertiary Health Care Centre: A 5 year Retrospective Study
Introduction: ER, PR and HER2 are the most important factors for predicting prognosis and response to treatment. In the present study we retrospectively measured the frequency of estrogen receptor (ER), progesterone receptor (PR), and Her 2 Neu positivity in breast cancer patients during a span of 5 years and classified them into luminal A (estrogen receptor/progesterone receptor [ER/PR]-positive and human epidermal growth factor receptor-2 [HER2]-negative), luminal B (ER/PR- positive and HER2-positive), HER2 (ER/PR-negative and HER2-positive), and triple negative (ER/PR- and HER2-negative) molecular subtypes. In this study we have also tried to correlate various molecular subtypes of breast cancer with age distribution, histological grade, lymph node status and distant metastasis.
Methodology: We conducted a 5-year retrospective study on 547 patients. Clinical data including the age, sex, lymphnode status along with histological type and, grade of the tumour were recorded and the cases were subjected for immunohistochemical evaluation of HER-2/neu, ER, PR receptor status.
Results: The results showed that HER2 neu was the most predominant immunomarker, while ER and PR was almost half of it. Among the molecular sub typing HER 2 type was the most prevalent constituting 53% of the cases, followed by almost triple negative and luminal A subtype with 20% cases each. Luminal B was least frequent with 9% of the cases. An inverse relationship exists between expression of her 2 neu and ER/PR. Conclusion: Our study concluded that molecular subtyping of breast carcinoma is an important part of complete histopathology report, in terms of prognosis, recurrence and treatment. A shift in occurrence of breast malignancies towards younger age leads to increased Her-2 neu expression.
2. Jain SA, Aggrawal L,Ameta A, Nadkarni S, Goyal A, Ranjanet al.Study of ER, PR & HER-2/NEU reactivity pattern in the patient of Breast Cancer in northern part of India.IOSR Journal of Dental and Medical Sciences.2014;13:09-19.
3. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype. Cancer. 2007; 109:1721–1728.
4. Goud KI, Dayakar S, Vijayalaxmi K, Babu SJ, Reddy PV. Evaluation of HER-2/neustatus in breast cancer specimens using immunohistochemistry (IHC) & fluorescence in-situ hybridization (FISH) assay.Indian J Med Res.2012;135:312-317.
5. Panjwani P, Epari S, Karpate A, Shirsat H, Rajsekharan P, Basak R, et al. Assessment of HER-2/neu status in breast cancer using fluorescence in situ hybridization and immunohistochemistry: Experience of a tertiary cancer referral centre in India. Indian J Med Res 2010;132:287-94.
6. Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metatstatic breast cancer that overexpresses HER2. N Engl J Med 2001; 344 : 783-92.
7. Bilancia D, Rosati G, Dinota A, Germano D, Romano R, Manzione L. Lapatinib in breast cancer. Ann Oncol2007; 18 (Suppl 6): 26-30.
8. Barnes DM, Hanby AM. Oestrogen and progesterone receptors in breast cancer: past, present and future. Histopathology, 2001; 38, 271-4.
9. Azizun-Nisa, Bhurgri Y, Raza F, Kayani N. Comparison of ER, PR & HER-2/neu (C-erb B 2) Reactivity Pattern with Histological Grade, Type, Tumour Size and Lymph Node Status in Breast Cancer. Asian Pacific Journal of Cancer Prevention.2008;9:553-56.
10. Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol.2010;28: 1684-91.
11. Carey LA, Cheang MCU, Perou CM. Chapter 29: Genomics, Prognosis, and Therapeutic Interventions, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 5th edition, Lippincott Williams & Wilkins, 2014.
12. Atchley DP, Albarracin CT, Lopez A, Valero V, Amos CI, Gonzalez-Angulo AM et al. Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer. J Clin Oncol.2008; 26:4282-8.
13. Ambroise M, Ghosh M, Mallikarjuna VS, Kurian A. Immunohistochemical Profile of Breast Cancer Patients at a Tertiary Care Hospital in South India. Asian Pacific Journal of Cancer Prevention 2011;12: 625-29.
14. Nikhra P, Patel S, Taviad D, Chaudhary S. Study of ER (Estrogen Receptor), PR (Progesterone Receptor) & HER-2/NEU (Human Epidermal Growth Factor Receptor) expression by immunohistochemistry in breast carcinoma. International Journal of Biomedical and Advance Research 2014; 05:275-78.
15. Siadati S, Sharbatdaran M, Nikbakhsh N, Ghaemian N. Correlation of ER, PR and HER-2/Neu with other Prognostic Factors in Infiltrating Ductal Carcinoma of Breast. Iranian Journal of Pathology 2015; 10:221-226.
16. Ghosh J, Gupta S, Desai S, Shet T, Radhakrishnan S, Suryavanshi P et al. Estrogen, progesterone and HER2 receptor expression in breast tumors of patients, and their usage of HER2-targeted therapy, in a tertiary care centre in India. Indian J Cancer 2011; 48:391-6.
17. BhagatVasudha M, Jha Bharti M, Patel Prashant R. Correlation of Hormonal Receptor and Her- 2/neu Expression in Breast Cancer: A Study at Tertiary Care Hospital in South Gujarat, Natl J Med Res. 2012; 2: 295-298.
18. Munjal K, Ambaye A, Evans MF, Mitchell J, Nandedkar S, Cooper K. Immunohistochemical Analysis of ER, PR, Her2 and CK5/6 in Infiltrative Breast Carcinomas in Indian Patients. Asian Pacific Journal of Cancer Prevention 2009; 10:773-778.
19. Sharif MA, Mamoon N, Mushtaq S, Khadim MT. Morphological profile and association of HER-2/neu with prognostic markers in breast carcinoma in Northern Pakistan. J Coll Physicians Surg Pak. 2009;19:99-103.
20. Lund MJ, Trivers KF, Porter PL, Coates RJ, Leyland-Jones B, Brawley OW etal. Race and triple negative threats to breast cancer survival: a population-based study in Atlanta, GA. Breast Cancer Res Treat.2009;113:357-70.