Evaluation of Prognostic Factors in Triple Negative Breast Cancer Patients with Emphasis on Angiogenesis

Abstract

Developing new therapeutic methods and exploring other possible future strategies in Triple Negative Breast Cancer (TNBC) is an area of interest. Angiogenesis is one such sought for area that can even serve as a targeted therapy in this subset of breast cancer. The objective of the study was to evaluate the prognostic factors in TNBC patients with emphasis on angiogenesis. Prospectively 120 patients with histologically confirmed breast cancer from June 2015 to July 2019 were included. The Colour Doppler evaluation of breast lump and axilla in terms of RI, PI and Vmax was done. Patients were categorized as having ‘high’ or ‘low’ RI, PI and Vmax on the basis of their mean value. Immunohistochemistry (IHC) was performed on viable tumour blocks obtained from mastectomy specimen using CD31 vascular endothelial staining. The idea was to obtain Microvascular Density (MVD) by counting all immunostained vessels at magnification of 400x. The association between TNBC and non TNBC with well-known Doppler parameters, tumour size, clinical lymph node status, number of positive lymph nodes, tumour grade, stage of disease and hormonal receptor status was investigated. Also the association between high and low MVD with these prognostic parameters were evaluated. A total of 120 patients were included in the study with the mean age of 42.43±7.73 years (range 30-65 years). The mean RI, PI and Vmax were 0.92±0.26, 2.19±1.84 and 16.52±10.70 respectively. The comparison between TNBC and non-TNBC with prognostic parameters showed significant association with age of patients, duration of disease, use of oral contraceptive pills (>1 year), tumour size, histological grade, RI and MVD (p=0.041, p=0.011, p=0.002, p=0.029, p=0.026, p=0.014 and p=0.007 respectively). The MVD value >13.17 (high) was found in 45 (37.5%) patients while 75 (62.5%) patients had low MVD value ( 16.52) was significantly associated with tumour size (p<0.001), axillary lymph node (p=0.022), clinical stage (p=0.015), histological grade (p<0.001), RI (p<0.001), ER status (p<0.001) and HER2 over expression (p=0005). TNBC is a subset of breast cancer showing aggressive biological behaviour as seen by presence of poor prognostic marker and increased vascularity.