الفهرس 
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Abstract
This study included40female patients, their age between 18 and 70 years, with pathologically proven invasive breast carcinoma. All patients are stage II or III with ECOG performance status 0-1. All patients were treated in Alexandria Armed Forces Hospital, Oncology Department .
All patient had US guided core biopsy from breast lump and/or axillary LNs and then underwent pathological examination by (IHC) for (ER ,PgR , HER2/neu and Ki67).
The primary diagnostic workup for all patients included full laboratory investigations (including CBC, LFTs, KFTs and tumor markers), bilateral mammography, MSCT chest, US/or CT abdomen, echocardiography and bone scan .
All patients received 4 cycles of neoadjuvant taxane based chemotherapy with
TAC protocol (docetaxel 75mg/m2, doxorubicin 50mg/m2, cyclophosphamide
500mg/m2).After chemotherapy, all patients were evaluated for clinical response (either complete response [CR], partial response [PR] or no response (15)) by US of breast and axilla.
Patients then were referred to surgery. Excised breast and axillary tissues were pathologically examined for any residual tumor cells and if found, another IHC for (ER, PgR , HER2/neu and Ki67) was done.
The aim of this study was to determine whether the status of different molecular subtypes of breast cancer depending on the status of (ER, PgR, HER2/neu) and the proliferative index Ki67 could affect the pattern of pathological response to taxane based neoadjuvant chemotherapy andto determine the adjuvant treatment protocols according to postoperative assessment of the response and these parameters (either hormonal therapy, chemotherapy and/or adjuvant trustazumab).
The following results were obtained from this study:
The median age in this study was 55 with 52% of patients between the ages of
40-50.
In this study, 70% of the patients were premenopausal and 30% were
postmenopausal .All patients were presented by breast lump and only 33 patients (82.5%) had axillary mass, 6 patients (15%) had skin manifestations. Also, 55% of the patients were with right sided and 45% were with left sided breast cancer.
All patients underwent radiological and laboratory investigations before treatment and tumor marker (CA15.3) was found to be elevated in 70% of patients and normal in 30% of them.
The staging of the patients according to T-stage showed that 15% of patients were with T1 tumor, 67% were T2, 7.5 % were T3 and 10% were T4 tumors. Regarding the tumor grading, 5% of patients were with grade I tumors, 60% were with grade II tumors and 35% were with grade III tumors.
The pathological examination of the tumor showed that, 95% of patients had infiltrating ductal carcinoma type and 5% were with infiltrating lobular type and 82.5% of patients had node positive disease and 17.5% had node negative disease.
Patients were classified according to the status of ER, PgR, HER2 and Ki 67 into 5groups, luminal A (17.5%), luminal B (42.55%), luminal B HER2 type (15%), HER2 overexpression (12.5%) and triple negative (12.5%).
from all of the patients 12.5% showed pCR, 80% showed partial response and
7.5% showed no response to neoadjuvant chemotherapy. Univariate analysis revealed that 10% of either ER +ve or PgR +ve patients showed pCR and 20% of ER-ve or PgR- ve also showed pCR which was statistically significant (p value 0.043). Also, 27.3% of HER2 +ve patients and 6.9% of HER2 –ve patients showed pCR which was also statistically significant (p value 0.014). None of the cases with low Ki67 and 18.5% of high Ki67 cases showed pCR (statistically significant with p value of 0.027).
In luminal A group (0% showed pCR, 100% showed partial response and 0% showed no response). In luminal B group (5.9% showed pCR , 94.1% showed partial response and 0% showed no response). In luminal B HER2 type group (33.3% showed pCR , 66.7% showed partial response and 0% showed no response ). In HER2 overexpression group (20% showed pCR, 60% showed partial response and 20% showed no response). In triple negative group (20% showed pCR, 40% showed partial response and 40% showed no response).
The conclusion from the previous results was that, there is a relation between molecular subtypes of breast cancer and the pathological complete response and it was found to be statistically significant with P value of (0.036).
Also, there was minimal change in the status of ER, PgR and Ki67 which was statistically insignificant (p-value 0.425, 0.425 and 0.72 respectively) and there was no change in the status of HER2/neu.
There was also statistically significant association between the status of Ki67 and the pathological response to neoadjuvant taxane-based chemotherapy (P value
0.027).