Abstract
Breast Cancer is the most common cancer in women in India and constitute one–third of women’s cancers and is second reason of mortality after lung carcinoma.[1] It is the most commonly diagnosed malignancy in most cities in India, and 2nd most common cancer in females in the rural areas. As the disease burden and mortality rate is very high, evaluation of several parameters that influence survival rates among women with breast cancer may help design early detection, predict the prognosis and frame a suitable line of treatment.[2] The link between inflammation and cancer was first suggested in 1863.[3] Chronic inflammation is known to increase the risk of cancer development, such as colon cancer in inflammatory bowel diseases.[4] There is good evidence that the development of cancer and its progression are dependent on a complex interaction of the tumour and the host inflammatory response.[5] Aim: This study aims to correlate the relation of inflammatory cell infilteration with tumour staging, nodal status, ER, PR, HER-2 NEU status of breast cancer. Material and Method: The proposed study was a cross sectional study with mostly prospective observation and with some retrospective observation, included 74 patients of stage II and stage III breast carcinoma who underwent MRM in Cancer Institute from 2017-2018. The various clinical and histopathological prognostic parameters along with inflammatory cell infilterate score in invasive breast carcinoma patients were studied and correlated. The inflammatory cell infilterates was assessed according to Klintrup-Makinen (K-M) criteria. It is scored on 4 point scale where score 0 defined no increase in inflammatory cell infilterate, score 1 defined as mild or patchy increase ,score 2 denoted as prominent inflammatory response with some cancer cell destruction and score 3 as florid cup like response. Further it is classified as low group score (score 0-1)and high group score (score 2-3) .[6] Result: There was significant association between inflammatory cell infiltrate score and grade of tumor (p=0.0005) (TABLE 1) .58.1% ,54.1% and 37.8% of the cases were ER, PR and Her-2/neu positive respectively. ER negative tumors (74.19%) were showing statistically significant (p= 0.01) association with high inflammatory cell infilterate score (ie. Score 2 and 3). Similarly PR negative tumors (64.7%) were showing statistically significant association (p= 0.04) with high inflammatory cell infilterate score. No such correlation was found between between HER-2 /NEU status and nodal involvement with inflammatory cell infilterate score (TABLE 3). Keywords: Breast cancer, Invasive ductal carcinoma, ER , PR , HER-2/Neu ,grade of tumor, Nodal status, inflammatory cell infilterate score.
Highlights
Prognosis of breast carcinoma depends on various clinical factors, histopathological parameters, hormone receptors and molecular based markers
Though the main function of the immune system is to monitor tissue homeostasis, protect against invading or infectious pathogens and to eliminate damaged cells but several clinical and experimental studies on carcinogenesis have revealed the complex relationship between immune cells and its promoting effect on tumor. It helps in the proliferation and survival of malignant cells, promotes angiogenesis and metastasis, take off adaptive immune responses, and change responses to hormones and chemotherapeutic agents.[10,11]The stroma mainly consists of (1) the nonmalignant cells of the tumor such as carcinoma associated fibroblasts, specialized mesenchymal cell types distinctive to each tissue environment, innate and adaptive immune cells,[9,10] and vasculature with endothelial cells and pericytes[12,13] and (2) the extracellular matrix consisting of structural proteins like collagen and elastin, specialized proteins like fibrilin, fibronectin, and elastin, and proteoglycans [14]
After routine histopathological confirmation of Invasive Ductal Carcinoma as a diagnosis, tumor inflammatory cell infilterate score was assessed and those having known ER,PR and HER-2/neu by immune-histochemical techniques were included in this study
Summary
Prognosis of breast carcinoma depends on various clinical factors, histopathological parameters, hormone receptors and molecular based markers. Though the main function of the immune system is to monitor tissue homeostasis, protect against invading or infectious pathogens and to eliminate damaged cells but several clinical and experimental studies on carcinogenesis have revealed the complex relationship between immune cells and its promoting effect on tumor It helps in the proliferation and survival of malignant cells, promotes angiogenesis and metastasis, take off adaptive immune responses, and change responses to hormones and chemotherapeutic agents.[10,11]The stroma mainly consists of (1) the nonmalignant cells of the tumor such as carcinoma associated fibroblasts, specialized mesenchymal cell types distinctive to each tissue environment, innate and adaptive immune cells,[9,10] and vasculature with endothelial cells and pericytes[12,13] and (2) the extracellular matrix consisting of structural proteins like collagen and elastin, specialized proteins like fibrilin, fibronectin, and elastin, and proteoglycans [14]. Combined ER,PR HER2/Neu Low inflammatory High inflammatory Total score (score 0 &1) score (2&3)
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