Abstract
Background:Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer (BC), and its diagnosis is associated with negative expression of hormone receptors and HER2/neu. It consists of 10-20% of all BCs diagnosed. Methods and materials:This study focuses on three groups with different pathology: group one showed complete triple-negative HER2 expression with IHC of BC; groups two and three included patients with ER-, PR-, and HER21+, and ER-, PR-, and HER22+ with a negative FISH test. These three groups were compared from the point of prognosis, which consisted of tumor size, patients’ age, lymphatic, vascular and perineural invasion, organ metastasis, number of lymph nodes involvement, and the survival rate. Results:A total of 459 TNBC patients were enrolled, of which 268 were placed in the HER20 group, 146 in the HER21+ group, and 45 in the HER22+ group. Distant metastasis and recurrence rate were more common in HER20 patients, but bone metastasis was more common in patients with low HER2 expression. All patients with HER20 had a smaller tumor size at the time of BC diagnosis in comparison to patients in the low HER2 expression group. Patients with HER22+ had less lymphatic and vascular invasion as well as axillary lymph nodes involvement, but larger tumor size at presentation, resulting in a lower rate of recurrence and higher overall survival. Conclusion:The findings revealed that patients with HER22+ had better outcome in comparison to the patients with HER20 and HER21+. Furthermore, the results showed that many patients with HER22+ expression were not basal-like and had good prognosis amongst TNBC patients.
Highlights
Triple-negative breast cancer (TNBC) is a type of BC, which has higher mortality due to its more local recurrence and distant metastasis (Asano et al, 2017), which becomes more resistance to chemotherapy than other types of BC, resulting in shorter survival (Wang et al, 2015; Li et al, 2017) TNBC diagnosis was made possible by the negative expression of hormone receptors and human epidermal growth factor receptor 2 (HER2) neu, which was reported to account for 10-20% of all BC cases (Denkert et al, 2017) TNBC is categorized by the absence of three main biomarkers, i.e. estrogen and progesterone receptors, low expression of HER2 by immunohistochemistry (IHC), and lack of amplification by fluorescence in situ hybridization (FISH) test
The evaluation of the histopathological characteristics of the patients and a comparison of the lymphatic invasion showed a minimal higher rate of invasion in the HER20 and HER21+ groups, but the difference was not statistically significant.(P = 0.6) A comparison of the extent to which the right- and left-side breast were affected by the tumor showed that the right-side breast was affected more 66.6% (n = 30) by the tumor in the HER22+, but the difference was not statistically significant (P = 0.1)
This type of cancer is more aggressive than other BC types and has poorer prognosis compared to other BC types (Speers et al, 2017; Kucukzeybek et al, 2018) Recent studies revealed that BC heterogeneity extends to the classic IHC-based subtypes of Estrogen receptor (ER), progesterone receptor (PR), and HER2 receptors. (Gradishar et al, 2016; Kurozumi et al, 2016) Nowadays, new treatment methods are suggested for TNBC according to new biomarkers and gene expression profile (Burstein et al, 2015; Sarin et al, 2016)
Summary
Triple-negative breast cancer (TNBC) is a type of BC, which has higher mortality due to its more local recurrence and distant metastasis (Asano et al, 2017), which becomes more resistance to chemotherapy than other types of BC, resulting in shorter survival (Wang et al, 2015; Li et al, 2017) TNBC diagnosis was made possible by the negative expression of hormone receptors and human epidermal growth factor receptor 2 (HER2) neu, which was reported to account for 10-20% of all BC cases (Denkert et al, 2017) TNBC is categorized by the absence of three main biomarkers, i.e. estrogen and progesterone receptors, low expression of HER2 by immunohistochemistry (IHC), and lack of amplification by fluorescence in situ hybridization (FISH) test. The results showed that many patients with HER22+ expression were not basal-like and had good prognosis amongst TNBC patients
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