ارتباط بین بروز بیش از حد گیرنده HER2 با میزان بازگشت مشاهده شده سرطان پستان

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی اراک، اراک، ایران.

2 دانشجوی دکتری تخصصی اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران

3 دستیار تخصصی داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی اراک، اراک، ایران.

چکیده

مقدمه: سرطان پستان، شایعترین سرطان زنان در ایران و جهان می باشد و HER-2 یکی از عوامل تشخیصی این سرطان است. در بسیاری از سرطان ها، از تومور مارکرها به عنوان معیار پیش بینی کننده بازگشت استفاده می شود اما در سرطان پستان، معاینه بالینی و ماموگرافی، مهمترین عوامل جهت پیگیری بازگشت توصیه شده اند. مطالعه حاضر با هدف بررسی ارتباط بین بازگشت و تومور مارکر HER-2 در مبتلایان به سرطان پستان در شهر اراک انجام شد.
روش کار: این مطالعه مقطعی بر روی 140 بیمار مبتلا به سرطان پستان که در فاصله سال های 89-1385 به بیمارستان آیت ا... خوانساری شهر اراک مراجعه کرده بودند، انجام شد. نمونه بافتی این بیماران از نظر گیرنده های استروژن، پروژسترون و HER-2 با روش ایمونوهیستوشیمی ارزیابی شد. بیماران در بدو ورود، تحت معاینه بالینی کامل و سی تی اسکن قفسه سینه قرار گرفتند. سپس بعد از جراحی و دایسکشن تمام غدد لنفاوی درگیر توسط انکولوژیست تحت درمان مناسب سرطان پستان قرار گرفتند و به مدت 2 سال از نظر هرگونه علائم بازگشت پایش شدند. تجزیه و تحلیل داده ها با استفاده از نرم افزار آماری SPSS (نسخه 16) و آزمون کای دو انجام شد. میزان p کمتر از 05/0 معنی دار در نظر گرفته شد.
یافته ها: از مجموع 140 بیمار مورد مطالعه، 102 نفر (85/78%) درگیری غدد لنفاوی داشتند. بین گیرنده های HER-2، استروژن و پروژسترون با میزان درگیری غدد لنفاوی ارتباط معنی داری وجود نداشت (05/0<p). میزان بازگشت در بیماران مبتلا به سرطان پستان با HER-2 مثبت، 1/42% و در بیماران با HER-2 منفی‌، 6/25% بود. میزان بازگشت در دو گروه بیماران مبتلا به سرطان پستان HER-2 مثبت و منفی اختلاف معنی داری نداشت (16/0=p)
نتیجه گیری: بین بازگشت سرطان پستان و بروز بیش از حد HER-2 ارتباطی وجود ندارد.

کلیدواژه‌ها


عنوان مقاله [English]

The Relationship between HER2-Overexpressing and Incidence of Breast Cancer Recurrence

نویسندگان [English]

  • Kamran Moshfeghi 1
  • Amir Almasi Hashiani 2
  • Javad Motezaker 3
1 Assistant Professor, Department of Internal Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
2 Ph.D. Student of epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran.
3 Resident of Internal Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
چکیده [English]

Introduction: Breast cancer is the most common cancer in women worldwide and HER-2 is one importantly prognostic factor in this cancer. Tumor markers use as a criterion for predicting recurrence, but in breast cancer physical examination and mammography are important factors that are recommended for following up the recurrence. The aim of this study was to assess the correlation between breast cancer recurrence and HER2-overexpressing in breast cancer patients in Arak, Iran.
Methods: This cross-sectional study was conducted on 140 patients with primary breast cancer referred to Ayatollah Khansari hospital of Arak, Iran during 2006-2010. Estrogen and progesterone receptors and HER-2 expression were evaluated by immunohistochemistry procedure in tissue samples. At arrival patients underwent complete physical examination and chest CT-scan. After operation and dissection of involved lymph node, patients treated properly by oncologist and followed up for 2 years for recurrence of symptoms. Data were analyzed by SPSS software version 16 and Chi-square test. P value less than 0.05 was considered significant.
Results: Out of 140 cases, 102 patients (78.85%) had lymph node metastasis. No significant association was found between HER2, estrogen and progesterone receptors and lymph node metastasis (p>0.05). Rate of recurrence was 42.1% in HER2 positivecases and 25.6% in HER2negative. Rate of recurrence in both HER2 positive and HER2 negative groups showed no statistically significant difference (p=0.16).
Conclusion: There is no significant relation between breast cancer recurrence and over expression of HER2.

کلیدواژه‌ها [English]

  • Breast neoplasms
  • HER2
  • Receptor/Estrogen
  • Receptor/Progesterone
  • Recurrence
  1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011 Jul-Aug;61(4):212-36.
  2. Moradi-Marianeh M, Homaei-Shandiz F, Shamsian SA, Eftekharzadeh Mashadi I, Hedayati-Moghadam M. [Association of HER2/neu,p53 genes, estrogen and progesterone receptors with survival in Iranian women with breast cancer] [Article in Persian]. Iran J Breast Dis 2008;1(2):7-17.
  3. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012 Jan-Feb;62(1):10-29.
  4. Devita VT, Hellman S, Rosenberg S. Cancer, principles and practice of oncology. 6th ed. Philadelphia:Lippincott Williams and Wilkins;2001.
  5. Yamashita H, Nishio M, Toyama T, Sugiura H, Zhang Z, Kobayashi S, et al. Coexistence of HER2 overexpression and p53 protein accumulation is a strong prognostic molecular marker in breast cancer. Breast Cancer Res 2004;6(1):R24-30.
  6. Lippman ME. Breast cancer. In: Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo G. Harrison's principles of internal medicine. 18th ed. New York:McGraw-Hill;2012:754-63.
  7. Rosselli Del Turco M, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA 1994 May 25;271(20):1593-7.
  8. de Bock GH, Bonnema J, van der Hage J, Kievit J, van de Valde CJ. Effectiveness of routine visits and routine tests in detecting isolated locoregional recurrences after treatment for early-stage invasive breast cancer: a metaanalysis and systematic review. J Clin Oncol 2004 Oct 1;22(19):4010-8.
  9. King CR, Kraus MH, Aaronson SA. Amplification of a novel v-erbB-related gene in a human mammary carcinoma. Science 1985 Sep 6;229(4717):974-6.
  10. Klapper LN, Glathe S, Vaisman N, Hynes NE, Andrews GC, Sela M, et al. The ErbB-2/HER2 oncoprotein of human carcinomas may function solely as a shared coreceptor for multiple stroma-derived growth factors. Proc Natl Acad Sci U S A 1999 Apr 27;96(9):4995-5000.
  11. Karunagaran D, Tzahar E, Beerli RR, Chen X, Graus-Porta D, Ratzkin BJ, et al. ErbB-2 is a common auxiliary subunit of NDF and EGF receptors: implications for breast cancer. EMBO J 1996 Jan 15;15(2):254-64.
  12. Giatromanolaki A, Koukourakis MI, Simopoulos C, Polychronidis A, Gatter KC, Harris Al, et al. c-erbB-2 related aggressiveness in breast cancer is hypoxia inducible factor-1alpha dependent. Clin Cancer Res 2004 Dec 1;10(23):7972-7.
  13. Yaziji H, Goldstein LC, Barry TS, Werling R, Hwang H, Ellis GK, et al. HER-2 testing in breast cancer using parallel tissue-based methods. JAMA 2004 Apr 28;291(16):1972-7.
  14. Owens MA, Horten BC, Da Silva MM. HER2 amplification ratios by fluorescence in situ hybridization and correlation with immunohistochemistry in a cohort of 6556 breast cancer tissues. Clin Breast Cancer 2004 Apr;5(1):63-9.
  15. Gilcrease MZ, Woodward WA, Nicolas MM, Corley LJ, Fuller GN, Esteva FJ, et al. Even low-level HER2 expression may be associated with worse outcome in node-positive breast cancer. Am J Surg Pathol 2009 May;33(5):759-67 .
  16. Tetu B, Brisson J. Prognostic significance of HER-2/neu oncoprotein expression in node-positive breast cancer. The influence of the pattern of immunostaining and adjuvant therapy. Cancer 1994 May 1;73(9):2349-65.
  17. Rao AV, Mohammad WA, Ragoonanan C, Omo-Igbinomwanhia NE. Evaluation of oestrogen and progesterone receptors, and c-erbB-2 in carcinoma of the breast in Trinidadian women. West Indian Med J 2002 Mar;51(1):4- 9.
  18. Tulbah AM, Ibrahim EM, Ezzat AA, Ajarim DS, Rahal MM, El Weshi AN, et al. HER-2/Neu overexpression dose not predict response to neoadjuvant chemotherapy or prognostic survival in patients with locally advanced breast cancer. Med Oncol 2002;19(1);15-23.
  19. Yamauchi H, Hayes DF, Gralow JR, Dizon DS. HER2 and predicting response to therapy in breast cancer. Available at: http://www.uptodate.com/contents/her2-and-predicting-response-to-therapy-in-breast-cancer
  20. Najafi B, Fakheri T, Fadakar Sogheh Gh. [Relationship of HER-2 with other clinicalpathological diagnostic criteria in breast cancer patients] [Article in Persian]. J Med Facul GuilanUniv Med Sci 2006;15(57):21-7.
  21. Mofid B, Jalali Nodushan M, Kiani L, Zayei F. [ Association of HER2 with prognostic factors of breast cancer] [Article in Persian]. Pejouhesh 2004;28(1):29-32.
  22. National cancer institute at the national institute of health. Breast cancer risk in American women. Available at: http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer .
  23. Moosavi M, Mohebbi H, Teimoori M, Lalolii A. [Relationship between age and estrogen, progestron, ki-67 and Her-2 / neu tumor marker in breast tumor] [Article in Persian]. Iran J Breast Dis 2010;3(1):7-13.
  24. Allred DC, Clark GM, Tandon AK, Molina R, Tormey DC, Osborne CK, et al. HER-2/neu in node-negative breast cancer: prognostic significance of over expression influenced by the presence of in situ carcinoma. J Clin Oncol 1992 Apr;10(4):599-605.
  25. Kumar-Sinha C, Ignatoski KW, Lippman ME, Ethier SP, Chinnaiyan AM. Transcriptome analysis of HER2 reveals a molecular connection to fatty acid synthesis. Cancer Res 2003 Jan 1;63(1):132-9.
  26. Sirati F, Yadegari K. [Determination of the correlation between Her-2 tumor factor and invasion of breast cancer to auxiliary lymph nodes in patients undergoing mastectomy in Cancer Institute (2001-2003)] [Article in Persian]. J Iran Univ Med Sci 2004;11(43):781-8.
  27. Shamsalinia A, Keihanian S, Ghaffari F, Mansore Saravi M, Najafi Ashtiani M. [Association between expression of Her-2/neu gene and estrogen receptors, progesterone receptors and p53 gene among female with primary breast cancer] [Article in Persian]. Iran J Obstet Gynecol Infertil 2010;13(1):43-8 .
  28. Mirmalek SA, Elhamkani E, Mahmoodzadeh H. [The role of HER-2 in prognosis and treatment of breast cancer: article review] [Article in Persian]. Iran J Surg 2005;13(2):7-21.
  29. Hayes DF. Steady progress against HER2-positive breast cancer. N Engl J Med 2011 Oct 6;365(14):1336-8.
  30. Colon E, Rayer JS, Gonzalez Keelan C, Climent-Peris C. Prevalence of steroid receptor and HER2/neu in breast cancer biopsies of women living in Puerto Rico. P R Health Sci J 2002 Dec;21(4):299-303.
  31. Kroger N, Milde-Langosch K, Riethdorf S, Schmoor C, Schumacher M, Zander AR, et al. Prognostic and predictive effects of immunohistochemical factors in high-risk primary breast cancer patients. Clin Cancer Res 2006 Jan 1;12(1):159-68.
  32. Stankov A, Bargallo-Rocha JE, Silvio AN, Ramirez MT, Stankova-Ninova K, Meneses-Garcia A. Prognostic factors and recurrence in breast cancer: experience at the national cancer institute of Mexico. ISRN Oncol 2012;2012:825258.