Research ArticleCorrelation of Her-2 neu over-expression with clinico pathological features of carcinoma breast
Introduction
The classical clinico pathological features such as tumour size, axillary node status, histological type and grade have a well-established prognostic role in breast cancer. However, they do not allow patients to be stratified for appropriate therapy on an individual basis. Biological markers such as oestrogen (ER) and progesterone receptors (PR) are of value in individualizing therapy and have become standard of care. Similarly, assessment of Her-2 neu over-expression has become the norm because it provides both prognostic and therapeutic information.
There is no consensus in literature on the relationship between Her-2 neu over-expression and the classical clinico pathological features.1, 2 But, nearly all investigators report an inverse relationship between Her-2 neu status and hormone receptors in diverse populations.3, 4, 5 The purpose of this study was to verify whether such correlations existed in our patients. To this end, the association between Her-2 neu over-expression and oestrogen and progesterone receptor status (both independently and jointly) and other clinico pathological features, that is, tumour size, node status, type of tumour and grade of tumour were studied.
Section snippets
Patients and methods
This was a prospective study accumulating 150 breast cancer patients over a 5 year period from 2004. All specimens of definitive surgery were fixed in 10% formaldehyde, embedded in paraffin, sectioned and stained with Haematoxylin/Eosin. Pathological staging (pTNM),6 determination of tumour type as per WHO classification,7 and grading by the Nottingham system8, 9 was done.
ER and PR status were assessed by immuno histochemistry either on the pre operative core biopsy sample or the surgical
Statistical analysis
All statistical analyses were performed with SPSS software version 15.1 for Windows (SPSS Inc, Chicago, Illinois, USA) and Epi Info™ (Version 6). The χ2 test was used to examine the association between Her-2/neu status and the various categorical variables in univariate analysis. p values less than 0.05 were accepted as significant.
Results
Table 1 summarises the clinico pathological features of all 150 patients.
Her-2 neu over-expression was seen in 35 (23.3%) out of the 150 patients. The mean age of the patients was 51.29 years. The youngest patient was 26 and the oldest 85 years. Only 7 out of 25 patients (28%) who were ≤age 40 were Her-2/neu positive. In the 125 who were ≥41 years, 28 (22.4%) were Her-2 neu positive. For younger vs. older patients: Odds ratio = 1.35. 95% CI 0.46–3.87. Relative risk = 1.25 (p = 0.7298443 Yates
Discussion
Classical clinical and morphological prognostic factors, such as tumour size, axillary node status, histological grade and type, vascular invasion etc. have a well-established role in the management of breast cancer.
Advances in the understanding of the molecular and genetic alterations underlying breast cancer development and progression have resulted in the identification of a great number of cell biological markers which are of potential value in individualizing therapy.12, 13
The HER-2 neu
Conclusion
The estimation of ER, PR and Her-2 neu in breast cancer is now standard of care, but the relationship between these and other traditional prognosticators is still not clear. In this study of 150 breast cancers, significant correlation between Her-2 neu amplification and ER/PR negative tumours was found but such was not so with other clinico pathological parameters.
Presentation details
Organisation: Association of Surgeons of India, Tamil Nadu & Pondicherry State Chapter Conference (NAGASICON 2009).
Place: Kanya Kumari, Tamil Nadu.
Date: 2nd August, 2012.
Conflicts of interest
All authors have none to declare.
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