Immunohistochemical and Clinicopathological Factors Associated with Axillary Lymph Node Metastasis in Breast Cancer Patients of Northern Pakistan

Abstract

Background: Breast cancer is the most common type of tumors in Pakistani women, with axillary lymph node (ALN) positivity reported to be one of the most important prognostic factors.This study shows the distribution of various clinical and pathological variables including age, tumor size, grade, histologic subtype, and hormone receptor status among Pakistani women with and without ALN metastasis.Materials and Methods: A total of 245 cases of primary breast cancer from Northern Pakistan were analyzed in this study. Their clinical, pathological and immunohistochemical parameters, including estrogen receptor (ER), progesterone receptor (PR) and Her-2/Neu status, were extracted from previous histopathological reports and stratified based on the occurrence of ALN metastasis. Results: Occurrence of ALN metastasis was significantly different between older age patients above 50 years and younger age patients age <50 years [χ² (1, N=245) =14.6, p<0.001]. There was an increased number of metastases in large sized tumors >5cm in size (80%, n=60), [χ² (2, N=245) =23.1, p<0.001] and tumors with higher nuclear grade III (78.4%, n=40), [χ² (1, N=245) =5.1, p=0.02]. ALN metastasis was inversely associated with expression of estrogen receptor [χ² (1, N=245) =12.5, p<0.001], and progesterone receptor [χ² (1, N=245) = <0.001, p=0.99], while it was directly associated with Her-2/Neu expression [χ² (1, N=245) =5.63, p=0.01]. Conclusion: In Pakistani women, ALN metastasis was significantly associated with older age, tumor size, and high-grade tumors showing Her2/Neu expression and was inversely associated with ER, PR expression in breast tumors.

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

“…The ER+, PgR-and ER-, and PgR+ groups had 19 (14.6%) and 8 (6.1%) cases, respectively ( Table 3, Figure 2). In our set-up, the majority of breast cancers were negative for ER and PgR, especially in young females, which is contrary to western studies but comparable to studies done in the Asian population [2][3]5]. This is because most of the cases present at a very advanced stage of breast cancer.…”

“…One of the indicators of systemic adjuvant therapy is lymph node involvement by the tumor. It also determines the survival of the patients [3,12]. In this study, 90 (69.2%) cases showed metastatic tumor deposits in axillary lymph nodes.…”

“…In Pakistan, most of the cases present at a young age and advanced stage, contrary to the western world where it is commonly seen only after 60 years of age [9]. Pakistani women have the highest incidence rate of breast cancer in Asia accounting for one case in every nine women [3][4]9].…”

“…This is because most of the cases present at a very advanced stage of breast cancer. The advanced stage of breast cancer presentation in Pakistan is due to a lack of early screening programs, lack of awareness about screening programs, and low socioeconomic status [3]. Nabi et al showed that 59 (42.4%) cases were ER+PgR+, 60 (43.1%) cases were ER-PgR-, 10 (7.1%) cases were ER-PgR+ and ER+PgR-, respectively [7].…”

“…Breast cancer accounts for 24.4% of all cancers in the female Pakistani population while in the west, it accounts for 23% of cases [3][4]. Studies show that one out of nine Pakistani females is suffering from breast cancer [3][4]. Breast carcinoma is a heterogeneous disease with diverse histopathological types and molecular and clinical features.…”