الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common malignancy in women and the fifth cause of cancer mortality worldwide. Breast cancer is a heterogeneous disease characterized by a wide spectrum of many subtypes with distinct biological features that lead to differences in clinicopathological presentation.
Breast tumors with similar clinical and pathological presentations may have different behaviors. Analyses of breast cancer with new molecular techniques now hold promise for the development of more accurate assessment for the prediction of recurrence.
It is established that the incidence of breast cancer increases with age. The number of elderly patients with breast cancer is increasing and the majority of females who succumb to breast cancer are >65 years old. However, older patients are more likely to present with tumors that are estrogen receptor (ER)- and progesterone receptor (PR)-positive and human epidermal growth factor receptor 2 (HER2)-negative.
Breast cancer is the most common cancer of adolescents and young adult (AYA) women accounting for 5.6% of all invasive breast cancer in these women. In comparison with older women, AYAs are more likely to have familial cancer predisposition genes, larger breast tumors more than 3cm and unfavorable biological characteristics like Grade III.
Four clinically relevant molecular subtypes were revealed: Luminal A, Luminal B, enriched HER2 (HER2+), and Triple Negative (TN). Luminal A is the most common subtype, and This subtype has been associated with a highly favourable features such as low grade cancers, lower number of positive lymph nodes metastasis and absence of necrosis with a more indolent clinical course.
Luminal B is associated with an intermediate prognosis, with greater likelihood of locoregional recurrence when compared to Luminal A. HER2+ It represents 15% to 20% of newly diagnosed breast cancer cases and triple negative is a class of tumors constitutes from 10% to 20% of all breast cancer cases, These tumors are generally more prevalent in patients with BRCA1 mutations and young women, with a higher histological grade and contralateral disease.
There are significant differences in the age distribution by molecular subtype and the incidence of Her2 overexpression subtype decreases by age.Previous studies showed that the nature of the breast cancer in Egyptian patients are more of the favorable hormonal positive luminal subtype and the more aggressive triple negative subtype is not of higher incidence compared to other reports worldwide.
Younger patients with triple-negative and HER2-positive breast cancers have an increased risk of relapse within 5 years of diagnosis. Breast cancer that arises in young females is associated with reduced survival and higher incidence of unfavorable prognostic and predictive tumor markers.
The distribution of breast cancer subtype and grade changes with age, with more aggressive phenotypes among AYA compared with older women. Basal-like and Her2-enriched breast tumors are more common in young compared with older women. Worldwide, the treatment of breast cancer is now personalized, depending on the patient age, the stage and grade of disease, tumor size, histological type, molecular subtype, in addition to patient preferences regarding surgery and radiation.
The aim of this study was to correlate between clinicopathological characteristics and molecular subtypes and estimate the distribution of breast cancer subtype and characteristic.
A retrospective study was conducted on 1413 patients in Clinical Oncology department, Ain Shams University Hospitals from January 2018 to December 2020 diagnosed as breast cancer patients. Data was obtained from Patient’s available records in Clinical Oncology department, Ain Shams University Hospitals.
The results of our present study can be summarized as follows:
Our study showed that out of a total of 1404 breast cancer cases, 126 were HER2 enriched, 419 were luminal A, 438 were luminal B HER2-negative, 275 were luminal B HER2-positive, and 146 were triple-negative.
Of the 1404 patients with complete immunohistochemical data for estrogen receptor (ER), progesterone receptor (PR), and HER2, 50.9% of tumors were luminal B, 29.8% of tumors were lumina A, 10.4% of tumors were triple –ve on clinical assays for ER, PR and HER2 followed by HER2 enriched 8.9%.
In our study, there was a significant association between menopausal states and molecular subtypes, where 67.8% of luminal A were post-menopausal and 55% in luminal B with p value less than 0.001
In this study, there was no significant association between menopausal states and clinical/pathological stages (p value = 0.06).
This study showed that, there was no significant association between family history and clinical or pathological staging with p value 0.07.
In our study, according to molecular subtypes and family history there is no statically approved significant association with p value 0.68
Our study showed that, age of the patients was between 27-92 years old.
In this study, from 1404 patient, there were 153 patients stage IV. Bone was the most common site of Mets followed by lung then liver. when we collected date each site was collected separately even it was more than one site.
In our study, according to the distribution of molecular subtypes by age group. The incidence of luminal breast cancer (luminal A and luminal B) increase with age with p value less than 0.001, whereas the incidence of HER2 enriched and triple -ve decrease with age.
In this study, in Ki67 analysis, Patients with high age or Ki 67 > 14% were more likely to have higher stage in breast cancer staging with an adjusted OR = 1.011 for age and OR = 0.73 for Ki67 concluding that patients with Ki67 > 14% are 1.37 times more likely to have higher stages than those with Ki67 < 14%.
Our study revealed that, invasive ductal carcinoma was the most common pathology (92%) followed by invasive lobular carcinoma (6%) and Carcinoma in situ (2%).
Our study showed that, grade II was the most common (87.8%) followed by grade III (12.2%)
In this study, there was association between clinical/ pathological stages and different molecular subtypes with p value less than 0.001.
In our study as regard prediction of breast cancer stage using ROC curve of Ki 67. For Ki 67 values more than 14%, the breast cancer stage is at least 2 (sensitivity = 55.5%, specificity = 50.2%, p = 0.015).