MEME KANSERLERİ SUBGRUPLARININ SIKLIĞI VE SAĞKALIM ÜZERİNE ETKİLERİ

Abstract

Meme kanseri kadınlarda en sık görülen kanser türüdür ve 40-44 yaş arası kadınlarda kanser ölümlerinin başlıca nedenidir. Son dönemlerde meme kanserinin tanısında, evrelendirilmesinde ve tedavisinde kaydedilen ilerlemeler, hastaların sağkalımlarında önemli ölçüde düzelme sağlamıştır. Uzun yıllardır histoloji ve morfolojinin ön planda tutulduğu bir klasifikasyon kullanılmaktadır. Fakat günümüzde, aynı tedaviye rağmen aynı histoloji ve klinik evredeki hastaların, yaşam seyirlerinin farklı olabildiği görülmüştür. Moleküler tanımlamalardaki farklılıkların prognoz üzerine etkili olduğu görülmüştür. Çalışmamızın amacı kliniğimizde tanı ve tedavi almış meme kanseri olgularının, değerlendirilmesidir. Çalışmaya kliniğimizde Ocak 2005 ile Ocak 2010 tarihleri arasında meme kanseri nedeniyle ameliyat edilen 74 hasta alınmıştır. Patoloji raporlarına göre hastalar, hormon reseptör ve c-erbB2 durumuna göre, Luminal A hormon reseptör pozitif ve Her–2 negatif , Luminal B hormon reseptör pozitif ve Her–2 pozitif , Triple negatif hormon Reseptör negatif ve Her–2 negatif ve Her-2 overekspresyonu hormon reseptör negatif ve Her– 2 pozitif olmak üzere 4 subgruba ayrıldı. Çalışmamızda olgular, yaş, tümör boyutu, lenf nodunun metastaz durumu, histolojik grade, histolojik tip, p53 mutasyonu, Ki-67 durumu, ameliyat türü, hastalıksız sağkalım ve genel sağkalım süreleri açısından değerlendirildi. İmmünohistokimyasal özellikleri itibariyle, 21 %28,4 hasta luminal A subgrubuna, 24 %32,4 hasta luminal B subgrubuna, 12 %16,2 hasta Her-2 overekspresyon subgrubuna, 17 %23 hasta Triple negatif subgruba dahil edildi. Hastaların, hastalıksız sağkalım sürelerinin ortalamaları sırasıyla, Luminal A subgrubunda 47,86 ay, Luminal B subgrubunda 45,17 ay, Triple negatif subgrupta 53,18 ay, Her 2 overekspresyonu subgrubunda 48,17 ay olarak saptandı. Hastalar sağkalımları açısından incelendiğinde; Luminal A subgrubunda 1 %4,8 hastada, Luminal B subgrubunda 3 %12,5 hastada, Triple negatif subgrupta 2 %11,8 hastada, Her 2 overekspresyonu subgrubunda 1 %8,3 hastada mortalite saptandı. Luminal A hasta subgrubunda; aksilla lenf nodu evresi, tümörün histolojik tipi, tümörün büyüklüğü sağkalım üzerine etkili bulunmuşken, Her-2 overekspresyonu hasta subgrubunda; yaş, aksilla lenf nodu evresi, tümörün büyüklüğü sağkalım üzerine etkili bulunmuştur. Meme kanserlerinin subgruplarına ayrılmasındaki amaç hormonoterapi ve monoklonal antikor bazında tedaviler yapılacak grupların seçimidir. Meme kanserlerininaçısından sınıflandırılması, uzun yıllardır kullanılan histoloji ve morfolojinin ön planda tutulduğu sınıflandırmaya alternatif olabilir. moleküler olarak gen ekspresyon profilleri

Keywords

• Meme kanseri moleküler sınıflama,Luminal A,Luminal B,Triple Negatif,Her-2 overekspresyonu

FREQUENCY OF BREAST CANCER’S SUBGROUPS AND EFFECT FOR SURVIVAL

Abstract

Breast cancer is the most common cancer type in women and major cause of cancer death in women between the ages of 40-44. Recently, advences in the diagnosis, staging and treatment of breast cancer, provided considerably improvement of patients survival. For many years, a classification has been used that kept in the forefront of histology and morphology. But nowadays, despite the same treatment of patients with the same histology and clinical stage, prognosis can be seen in different. The definitions of molecular differences has positive effects on prognosis. The purpose of this study, identify subgroup, and evaluate the effects on survival of the had diagnosis and treatment of breast cancer cases in our clinic. From January 2005 to January 2010, 74 patients who operated for breast cancer in our clinic were enroled in this study. Patients were divided into four subgroup according to hormone receptor and c-erbB2 status. These subgroups were; Luminal A hormone receptor positive and Her–2 negative , Luminal B hormone receptor positive and Her–2 positive , triple negative hormone receptor negative and Her–2 negative and Her-2 overexpressing hormone receptor negative ve Her–2 positive . In our study, patients age, tumor size, lymph node metastatic status, histological grade, histological type, p53 mutation, Ki-67 status, surgery type, disease free survival and overall survival times were analyzed. According to immunohistochemical characteristics, 21 28,4% patients were included in Luminal A subgroup, 24 32,4% patients were included Luminal B subgroup, 17 23% patients were included in triple negative subgroup, 12 16,2% patients were included Her-2 overexpressing subgroup. The mean disease free survival times of patients were 47,86 months for Luminal A, 45,17 months for Luminal B, 53,18 months for Triple negative, 48,17 months for Her-2 overexpressing. Patients were analyzed by means of survival, the mortality rate 4,8% for Luminal A, 12,5% for Luminal B, 11,8% for Triple negative, 8,3% for Her-2 overexpressing. Axillary lymph node stage, tumor histological type and tumor size were found to affect on survival in Luminal A subgroup. Age, axillary lymph node stage and tumor size were found to affect on survival in Her-2 overexpressing subgroup. The aim of seperation breast cancer to subgrups; determine the groups which to be treated with hormonal treatments or monoclonal antibody. In terms of gene expression profiles as a molecular classification of breast cancers are may be alternative for the classification used in the histology and morphology

Keywords

• Molecular classification of breast cancer,Luminal A,Luminal B,Triple Negative,Her-2 overexpressing

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31. Yazının alınma tarihi:08.04.2013
32. Kabül tarihi:30.04.2013
33. Online basım:02.05.2013
34. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi,2013;17:88-97