Clinicopathological Features of Young Versus Older Patients With Breast Cancer at a Single Pakistani Institution and a Comparison With a National US Database

Zeeshan, Sana; Ali, Basim; Ahmad, Khabir; Chagpar, Anees B.; Sattar, Abida K.

doi:10.1200/jgo.18.00208

Cited by 28 publications

(31 citation statements)

References 17 publications

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“…These discrepant observations may be attributed to the predominant aggressive tumor biology of our TNBC cohort where only 6% of the patient population was diagnosed with stage I disease and about 40% of the patients had axillary LN metastasis at initial diagnosis. The plausible factors associated with aggressive tumor biology among Pakistani women compared to Western, Asian, and African cohorts require further genetic and epidemiological studies ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Lack of Androgen Receptor Expression Selects for Basal-Like Phenotype and Is a Predictor of Poor Clinical Outcome in Non-Metastatic Triple Negative Breast Cancer

et al. 2020

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Background: Androgen receptor (AR) has emerged as a significant favorable prognostic indicator in estrogen receptor expressing (ER +) breast cancer (BCa); however, its clinical and biological relevance in triple negative breast cancer (TNBC) and association with cancer stem cell (CSC) markers remain ambiguous. Methods: We examined the immunohistochemical expression of AR in a cohort of stage I-III TNBC cases (n = 197) with a long-term clinical follow-up data (mean follow-up = 53.6 months). Significance of AR expression was correlated with prognostic biomarkers including cancer stem cell markers (CD44, CD24, and ALDH1), basal markers (CK5, CK14, and nestin), proliferation marker (ki-67), apoptotic marker (Bcl-2), and COX-2. Expression of CK5 and nestin was used for the categorization of TNBC into basal (TN, CK5 + , and/or nestin +) and non-basal (TN, CK5 − , and/or nestin −) phenotypes, and Kaplan-Meier curves were used for estimation of overall survival and breast cancer-specific survival (BCSS). Results: AR expression was observed in 18.8% of non-metastatic TNBC tumors. Expression of AR correlated with lower grade (P < 0.001) and conferred a favorable prognostic significance in patients with axillary lymph node metastasis (P = 0.005). Lack of AR expression correlated with expression of CSC phenotype (CD44 + /CD24 −) (P < 0.001), COX-2 (P = 0.02), basal markers (CK5: P = 0.03), and nestin (P = 0.01). Basal-like phenotype (TN, CK5 + , and/or nestin +) correlated with quadruple-negative breast cancer (QNBC) and showed a significant association with adverse prognostic markers including high proliferation index (P < 0.001), expression of COX-2 (P = 0.009), and CSC phenotype (CD44 + /CD24 − : P = 0.01). Expression of AR remained an independent prognostic indicator for improved overall survival (P = 0.003), whereas basal-like phenotype was associated with an adverse BCSS (P = 0.013). Conclusions: Assessment of AR and basal markers identified biologically and clinically distinct subgroups of TNBC. Expression of AR defined a low-risk TNBC subgroup associated with improved overall survival, whereas expression of basal markers Riaz et al. Androgen Receptor Expression in TNBC (CK5 and nestin) identified a high-risk subgroup associated with adverse BCSS. Integration of immunohistochemical analysis of AR and basal biomarkers to the assessment of TNBC tumors is expected to improve the prognostication of an otherwise heterogeneous disease.

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Section: Discussionmentioning

confidence: 99%

Lack of Androgen Receptor Expression Selects for Basal-Like Phenotype and Is a Predictor of Poor Clinical Outcome in Non-Metastatic Triple Negative Breast Cancer

et al. 2020

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“…This is comparable to the study performed in Pakistan and India, where 56.8%, 47.6%, and 58.5%cases were ≤50 years of age, respectively (Table 2 ). Zeeshan et al found that 27.4% of breast cancer patients were even younger than 40years [ 7 , 11 - 13 ].…”

Section: Discussionmentioning

confidence: 99%

Estrogen and Progesterone Receptor Expression in Breast Carcinoma and Its Association With Clinicopathological Variables Among the Pakistani Population

Sohail¹,

Sarfraz²,

Imran³

et al. 2020

Cureus

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The prognosis of breast cancer depends on the histological type, size of the tumor, tumor necrosis, skin, nipple and chest wall invasion, lymphovascular invasion, grade, stage, the status of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2), cell proliferation marker (ki-67), and type of therapy. Estrogen receptor and progesterone receptor expression in breast cancer is, so far, the most useful predictive marker. We have undertaken this study to find the expression of ER and PgR in breast carcinoma and its association with other prognostically important clinicopathological variables. Materials and methods In this cross-sectional study, a total of 130 cases of modified radical mastectomy that have been diagnosed as malignant on histopathology were collected from the pathology department of Allama Iqbal Medical College, Lahore, from January 2016 to May 2018. The demographic data and gross and microscopic findings were recorded. Immunohistochemistry (ER, PgR) was applied to suitable tumor sections and their status was evaluated semi-quantitatively by histopathologists using College American Pathologist (CAP) guidelines. Result Most of the breast cancer patients (69; 53.1%) were below 50 years of age. Fifty-nine (45.4%) and 48 (36.9%) cases were positive for ER and PgR, respectively, showing lower hormonal receptor positivity than that reported in the western population where ER expression has been found in 50%-80% of cases and PR expression is found in 60%-70% of cases of invasive ductal carcinoma. The association of the expression of hormone receptors with a clinicopathological variable was demonstrated. ER-/PgR-tumors showed a higher histologic grade, greater tumor size, and more lymph node involvement by metastasis.

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“…In our study, over 21% of all breast cancers occurred in women under 40 years of age. In other studies, percentages of breast cancer under 40 years of age have ranged from 17.2-27.4% [14,15]. A recent study from the United States argued that although approximately two third of women with breast cancer under 50 years of age are not high risk, women should receive annual mammograms from age 40 years since low risk does not confer protection [16].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study from the United States argued that although approximately two third of women with breast cancer under 50 years of age are not high risk, women should receive annual mammograms from age 40 years since low risk does not confer protection [16]. A recent study from a single institution in Pakistan which compared its ndings with a national US database found that breast cancer in Pakistani patients under 40 years of age was even more aggressive and advanced than breast cancer in a similar age group in the United States [15].…”

Section: Discussionmentioning

confidence: 99%

Differences in clinicopathological features and molecular phenotype of breast carcinoma between patients younger than 40 years and those who are older: A study from Pakistan

Idress

Rasheed

Abdul‐Ghafar³

et al. 2020

Preprint

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Background The debate whether breast cancer in women under 40 years of age is distinct from breast cancer in women above 40 is still inconclusive with various published studies providing conflicting evidence. The majority of studies however suggest that breast cancer in younger women (< 40) is more aggressive with worse clinicopathological features. However, the issue is by no means settled and a number of studies are still going on. Our objective was to analyze different clinicopathological variables and determine whether statistically significant differences are present between those under 40 and those above 40 years of age. The present paper contributes to this debate by reporting our findings. Methods Descriptive cross sectional study of 482 breast cancer cases reported between January and December 31, 2016 which included 380 patients (above 40 years of age) and 102 (under 40 years of age). Variables included grade, stage, axillary lymph node metastases, lymphovascular invasion and molecular groups. p-value less than 0.05 was taken as significant. Results Over 21% patients were younger than 40 years. Differences in histologic grade, stages of T1, T2, and T4, Estrogen Receptor (ER) and Progesterone Receptor (PR) status, Her2neu status, triple negativity and molecular groups between patients younger than 40 years and those older than 40 years were statistically insignificant. Differences in stage T3, axillary metastases and lymphovascular invasion were statistically significant. Conclusion Statistically significant differences were noted in some clinicopathological variables. Majority of variables indicating more aggressive disease were seen in patients older than 40 years of age. Additional studies with larger number of patients under 40 years of age are required to resolve the issue conclusively so that young women with breast cancer are not treated too aggressively unless there is unequivocal statistical evidence that breast cancer is more aggressive in patients under 40 years of age.

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Clinicopathological Features of Young Versus Older Patients With Breast Cancer at a Single Pakistani Institution and a Comparison With a National US Database

Cited by 28 publications

References 17 publications

Lack of Androgen Receptor Expression Selects for Basal-Like Phenotype and Is a Predictor of Poor Clinical Outcome in Non-Metastatic Triple Negative Breast Cancer

Lack of Androgen Receptor Expression Selects for Basal-Like Phenotype and Is a Predictor of Poor Clinical Outcome in Non-Metastatic Triple Negative Breast Cancer

Estrogen and Progesterone Receptor Expression in Breast Carcinoma and Its Association With Clinicopathological Variables Among the Pakistani Population

Differences in clinicopathological features and molecular phenotype of breast carcinoma between patients younger than 40 years and those who are older: A study from Pakistan

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