|Year : 2020 | Volume
| Issue : 4 | Page : 157-160
Clinical and estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 status correlation study in breast cancer patients: An experience from a tertiary care center
Rashmi Singh, Anup Kumar, Rajanigandha Tudu, Praveer Kumar Singh Munda
Department of Radiation Oncology, RIMS, Ranchi, Jharkhand, India
|Date of Submission||09-Jul-2020|
|Date of Acceptance||23-Jul-2020|
|Date of Web Publication||23-Nov-2020|
Dr. Rashmi Singh
Department of Radiation Oncology, RIMS, Ranchi, Jharkhand
Source of Support: None, Conflict of Interest: None
Background: Breast cancer is usually a systemic disease with outcomes dependent on various factors. We present here our departmental retrospective data of 74 breast cancer patients treated between January 2016 and October 2017, with a focus on various prognostic and predictive factors. Materials and Methods: Patients' details were retrieved from departmental case records regarding age, menopausal status, tumor size (T), axillary lymph node status (N), grade, and estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (Her2) status. Using SPSS software version 20.0, cross-tabulation, the Chi-square test, and Spearman correlation were applied where appropriate. Results: The median age of patients was 48.75 ± 11.08 years with more patients in premenopausal age (54.1%). Stage III was the most common presentation (66.2%). In addition, Grade 3 in tumor was most common (51.4%). ER(+), PR(+), and Her2(+) cases were 58.1%, 52.7%, and 28.4%, respectively. Nearly 29.7% of patients were triple negative. Grade of the tumor correlated significantly with tumor size and lymph node staging (P = 0.002). In addition, ER and PR expression was correlated with each other (P = 0.000). Conclusions: Advanced stage, higher tumor grade, and high prevalence of Triple-negative breast cancer in our patients are poor prognostic and predictive factors. Higher tumor grade is correlated with increased T and N staging, and tumor ER and PR expressions were correlated with each other.
Keywords: Breast cancer, clinical, estrogen receptor, human epidermal growth factor receptor-2, progesterone receptor
|How to cite this article:|
Singh R, Kumar A, Tudu R, Singh Munda PK. Clinical and estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 status correlation study in breast cancer patients: An experience from a tertiary care center. J Radiat Cancer Res 2020;11:157-60
|How to cite this URL:|
Singh R, Kumar A, Tudu R, Singh Munda PK. Clinical and estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 status correlation study in breast cancer patients: An experience from a tertiary care center. J Radiat Cancer Res [serial online] 2020 [cited 2021 Jan 15];11:157-60. Available from: https://www.journalrcr.org/text.asp?2020/11/4/157/301334
| Introduction|| |
As per the GLOBOCAN 2018 data, breast cancer is the most common cancer in Indian females (27.7%). There are various prognostic and predictive factors in breast cancer, for example, cT4, node positive, basal type molecular histology, lymphovascular invasion, positive/close margin, estrogen receptor (ER)/progesterone receptor (PR) negative, human epidermal growth factor receptor-2 (Her2) positive, triple negative, high Ki 67, aneuploidy, and multifocality. These factors have a strong impression on disease-free survival and overall survival. Triple-negative breast cancer (TNBC) patients have the worst outcome due to an increased risk of distant metastasis.
The present study is on breast cancer patients with a focus on clinical, ER, PR, and Her2 receptor status and evaluation of their intercorrelation.
| Materials and Methods|| |
This is a retrospective study, so ethical committee approval was exempted. All female breast cancer patients without metastatic disease treated in the department between January 2016 and October 2017 were included in the study. There were 74 eligible patients. Their pro formas were filled for age, menopausal status, tumor size (T), axillary lymph node status (N), and TNM staging as per AJCC (2018). Treatment details including modified radical mastectomy and chemotherapy and radiotherapy were noted. Furthermore, histopathology details including type, grade, tumor size, and lymph node staging and ER, PR, and Her2 receptor status were compiled. Statistical analysis was done using? SPSS software version 20 IBM SPSS statistics for windows, version 20 (IBM Corp; Armonk, N. Y, USA). Cross-tabulation, Chi-square test, and Spearman correlation were applied where applicable.
| Results|| |
Our patient population had a median age of 45.5 years (28–78 years). The majority of the patients (41.9%) were in the age group of 36–45 years, 35.1% of patients were in the age group of 46–60 years, and elderly (>60 years) and young patients (=35 years) constituted 13.5% and 9.5%, respectively.
There were more patients in the premenopausal group (54.1% vs. 45.9%).
cT3 and cT4 tumor size altogether was the most common presentation (68.9%), followed by T2 in twenty patients (27.0%). N3 nodal status was observed in 10.8% cases, and the rest nodal distribution was nearly equal for N1 and N2, figuring 31.1% (maximum) for N1. Stage-wise TNM, Stage III was the most common (66.2%), followed by Stage II (32.4%) and Stage I (1.4%). On grading, Grade 3 in breast tumor was the most common (51.4%), followed by Grade 2 (33.8%) and Grade 1 (12.2%).
Thirty-two (50%) patients were having both ER- and PR-positive status, whereas 28 (37.8%) patients were negative for both. Individual receptor status among the patient population was as 58.1% (ER+), 52.7% (PR+), and 28.5% (Her2+). Triple-positive tumors were in 14.9% of cases and 29.7% of cases were triple-negative tumor [Table 1].
On statistical analysis, we did not observe any relationship between tumor receptor expression and patient's menopausal status, tumor size, and lymph node staging. Tumor size and nodal staging were also not correlated. However, tumor grade showed a significant correlation with tumor size (R = 0.352; P = 0.022) and N staging (R = 0.267; P = 0.022). ER and PR status was significantly correlated to each other (R = 0.787; P = 0.000), but no such correlation was found with Her2 [Table 2].
|Table 2: Correlation between different prognostic and predictive factors|
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| Discussion|| |
Epidemiology of breast cancer across different population-based cancer registries in India is showing increasing trends for incidence and mortality.
Our study population had more patients in premenopausal than the postmenopausal group (54.1% vs. 45.9%). Kakarala et al. in a retrospective analysis of 1350 patients found more Caucasian women in postmenopausal age than Indian and Pakistani origin (53.9% vs. 75.5%).
Bansal et al. also observed 55.2% of patients in postmenopausal and 44.8% of cases were in the premenopausal women.
In our patients, cT3 and cT4 altogether were the most common presentation (68.9%), with the majority (66.2%) of patients catered in Stage III. However, Stage I was more common in Caucasians than Indian/Pakistani origin patients (51.0% vs. 36.3%) as observed in a SEER review.
Delayed disease presentation in Indian patients has been attributed to illiteracy, lack of awareness, financial constraints, lack of organized breast cancer screening program, and inertness toward female health in some sectors of India.
Higher grade in the tumor was more prevalent in our patients with Grade 3 being the most common one (51.4%), followed by Grade 2 and Grade 1 (33.8% and 12.2%), respectively. Furthermore, in a study by Rangarajan et al., Grade 3 was observed in 80% of cases in government hospitals and Grade 1 was in 9.5% of cases. Grade 1 is less common in low-socioeconomic status patients.
As per ASCO/CAP recommendations, ER and PR status to be determined in all invasive breast cancers and breast cancer recurrences. ER is considered the most powerful predictive marker in breast cancer treatment. ER concentrations are generally lower in tumor in premenopausal compared to postmenopausal women.
Among our patients, ER(+), PR(+), and Her2(+) cases were 58.1%, 52.7%, and 28.4%, respectively. We had more of TNBC (29.7%) than triple-positive (14.9%) cases. The Western population has higher ER+ (70%–80%) and PR+ (60%–70%) patients than in India. Studies have reported a variable percentage of Her2-positive cases (28%–46.3%)., Triple marker-positive cases were found to be 8.8%. The prevalence of TNBC is high in India (31%) than in the west, as suggested by various meta-analysis.
Reasons for more TNBC cases in India attributed to manual immunohistochemistry techniques, inappropriate fixation of the tumor specimen, and using mastectomy and lumpectomy specimen rather than core biopsies for testing. The use of improved quality-assured antibodies has improved the detection threshold of ER and PR.,
On correlation analysis, our patients' ER, PR, and Her2 receptor status did not show any significant association with menopausal status, tumor size, and lymph node staging. Tumor size and nodal staging also were found to be unrelated to each other.
However, Kakarala et al. observed a statistically significant correlation between ER/PR expression (among concordant cases) between <40 years and >40 years (P = 0.04). In a different study, no correlation was observed between Her2 and ER expression and also between ER and tumor size and lymph node staging. In contrary to this, the results of a positive correlation between ER and lymph node status were observed in other studies.,
It was observed that Her2 expression decreased with an increase in tumor size (P = 0.009) and stage (P = 0.04)., However, in other studies, no association was observed between Her2 receptor status and T size and lymph node status.,
In our study, tumor grade showed a significant correlation with tumor size (R = 0.352; P = 0.022) and N status (R = 0.267; P = 0.022). Other studies have reported a significant correlation between tumor grade and ER/PR (P = 0.01) and Her2 neu (P = 0.031). However, contrary findings were also observed.
We observed that ER and PR status was significantly correlated to each other (R = 0.787; P = 0.000). Another author did not observe such finding in their study; however, ER and PR status was significantly correlated with Her2 (P = 0.003).
| Conclusions|| |
Advanced stage, higher tumor grade, and the high prevalence of TNBC in our patients are poor prognostic and predictive factors. Higher tumor grade is correlated with increased T and N staging, and tumor ER and PR expressions were correlated with each other. Strong steps are the need of the hour for early diagnosis and appropriate treatment of breast cancer. Furthermore, the standardization of techniques for receptor testing can minimize false-negative reporting.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]