Meme kanseri subgruplarının sıklığı ve otoimmün tiroid hastalığının prognoz üzerine etkisi

Yıl 2021, Cilt: 2 Sayı: 4, 105 - 112, 21.12.2021

Ramazan Coşar , Aydın Çifci , Selim Yalçın , Aşkın Güngüneş , Şenay Arıkan Durmaz

https://doi.org/10.47582/jompac.993380

Öz

Amaç: Bu çalışmanın amacı meme kanseri moleküler subgrup sıklığını belirlemek ve meme kanseri tanısı ile takip ettiğimiz hastalarda otoimmun tiroid hastalığı (OİTH) ile meme kanseri prognostik ve prediktif faktörleri arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem: Retrospektif tanımlayıcı bir araştırma olarak planlanan bu çalışmaya 01 Ocak 2012–31 Aralık 2015 tarihleri arasında endokrinoloji ve tıbbi onkoloji polikliniklerine başvurmuş, meme kanseri tanısı ile takip edilen 101 hasta dahil edildi, moleküler sınıflandırmaya göre subgruplara ayrıldı. Yüksek serum anti-TPO düzeyi olanlar OİTH pozitif kabul edildi. OİTH’nin eşlik ettiği meme kanseri hastalarında prognostik ve prediktif parametreler (tümör evresi, tümör boyutu, aksiller lenf nodu tutulumu, histolojik derece, lenfovaskuler invazyonu, perinöral invazyonu, hormon reseptör durumu, HER2 ekspresyonu) otoimmün tiroid hastalığının eşlik etmediği meme kanseri hastaları ile karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen meme kanseri hastalarında tiroid otoimmunite (yüksek serum anti-TPO düzeyi) prevalansı %23,8 (n=24) olarak saptandı. OİTH pozitif meme kanseri hastalarında aksiller lenf nodu tutulumu (%37,5’e karşı %61; p=0,043) OİTH negatif meme kanseri hastalarına göre daha düşüktü. Diğer parametreler açısından iki grup arasında anlamlı fark izlenmedi.
Sonuç: OİTH’nin eşlik ettiği meme kanseri hastalarında önemli bir prognostik parametre olan aksiller lenf nodu tutulum oranı daha düşük bulunmuştur. Bu sonuç tiroid otoimmunitesinin meme kanseri açısından olumlu bir prognostik faktör olduğu görüşünü desteklemektedir. Bunun hangi mekanizma üzerinden etkili olduğu ise yeni çalışmalarla araştırılmalıdır.

Anahtar Kelimeler

Otoimmün tiroid hastalığı, meme kanseri, prognostik ve prediktif faktörler

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

The frequency of breast cancer subgroups and the effect of autoimmune thyroid disease on prognosis

Öz

Aim: The aim of this study is to determine the frequency of breast cancer molecular subgroups and to investigate the relationship between autoimmune thyroid disease (AITD) and breast cancer prognostic and predictive factors in patients followed up with a diagnosis of breast cancer.
Material and Method: This study, which was planned as a retrospective descriptive study, included 101 patients who applied to the endocrinology and medical oncology outpatient clinics between January 01, 2012 and December 31, 2015, followed up with the diagnosis of breast cancer, and were divided into subgroups according to molecular classification. Those with high serum anti-TPO levels were considered AITD positive. Prognostic and predictive parameters (tumor stage, tumor size, axillary lymph node involvement, histological grade, lymphovascular invasion, perineural invasion, hormone receptor status, HER2 expression) in breast cancer patients with AITD were compared with breast cancer patients without autoimmune thyroid disease.
Results: The prevalence of thyroid autoimmunity (high serum anti-TPO level) in breast cancer patients included in the study was 23.8% (n=24). Axillary lymph node involvement (37.5% vs. 61%; p=0.043) was lower in AITD-positive breast cancer patients than in AITD-negative breast cancer patients. No significant difference was observed between the two groups in terms of other parameters.
Conclusion: Axillary lymph node involvement, which is an important prognostic parameter, was found to be lower in breast cancer patients with AITD. This result supports the view that thyroid autoimmunity is a positive prognostic factor for breast cancer. The mechanism by which this is effective should be investigated with new studies.

Anahtar Kelimeler

Autoimmune thyroid disease, breast cancer, prognostic and predictive factors

Proje Numarası

-

Kaynakça

• American Cancer Society. Global Cancer Facts & Figures 3rd Edition. Atlanta: American Cancer Society; 2015.
• T.C. Sağlık Bakanlığı Kanserle Savaş Dairesi Başkanlığı. 2013 yılı Türkiye Kanser İnsidansı. www.kanser.gov.tr/Dosya/ca_istatistik/ANA_rapor_2013v01_2.pdf.
• Hoover R. Breast Cancer: Geographic, Migrant, and Time-Trend Patterns. In: Fortner JSP, ed. Accomplishments in cancer research. New York: Lippincott-Raven, 1996: 403-25.
• Fulford LG, Easton DF, Reis- Filho JS, et al. Specific morphological features predictive for the basal phenotype in grade 3 invasive ductal carcinoma of breast. Histopathology 2006; 49: 22-34.
• Gusterson AB, Ross TD, Heath JV, Stein T. Basal cytokeratins and their relationship to the cellular origin and functional classification of breast cancer. Breast Cancer Reseach 2005; 7: 143- 8.
• Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumours. Nature 2000; 406: 747–52.
• Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: A population-based study from the California Cancer Registry. Cancer 2007; 109: 1721-8.
• Giustarini E, Pinchera A, Fierabracci P, et al. Thyroid autoimmunity in patients with malignant and benign breast diseases before surgery. Eur J Endocrinol 2006; 5: 645-9.
• Jiskra J, Barkmanova J, Limanova Z. Thyroid autoimmunity occurs more frequently in women with breast cancer compared to women with colorectal cancer and controls but it has no impact on relapse-free and overall survival. Oncol Rep 2007; 18: 1603-11.
• Bloom H, Richardson W, Harrier E. Natural history of untreated breast cancer (1805-1933). BMJ 1962; 2: 213.
• Taylor R, Davis P, Boyages J. Long-term survival of women with breast cancer in New South Wales. Eur J Cancer 2003; 39: 215-22.
• Hardefeldt PJ, Eslick GD, Edirimanne S. Benign thyroid disease is associated with breast cancer: a meta-analysis. Breast Cancer Res Treat 2012; 133: 1169-77.
• Turken O, Narin Y, Demirbas S, et al. Breast cancer in association with thyroid disorders. Breast Cancer Res 2003; 5: 110–3.
• Newman LA. Epidemiology of locally advanced breast cancer. Semin Radiat Oncol 2009; 19: 195.
• American Joint Committee on Cancer. AJCC Cancer Staging Manual, 7thed.Philadelpia,PA:Lipincott Raven Publishers, 2010.
• Özmen, Tolga, Akkiprik M, Kaya H, Güllüoğlu BM. Meme kanseri ile otoimmun tiroid hastalığı ilişkisi; hormonal faktörler veya tiroglobulin gen polimorfizmi ortak etken olabilir mi? Meme Sagligi Dergisi/Journal of Breast Health 2014; 10: 35-41.
• Fredholm H, Eaker S, Frisell J, et al. Breast cancer in young women: poor survival despite intensive treatment. PLoS One 2009; 4: e7695.
• Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 2008; 26: 3324-30.
• Bastiaannet E, Liefers GJ, de Craen AJ, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat 2010; 124: 801-7.
• van de Water W, Markopoulos C, van de Velde CJ, et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA 2012; 307: 590-7.
• Partridge AH, Gelber S, Piccart-Gebhart MJ, et al. Effect of age on breast cancer outcomes in women with human epidermal growth factor receptor 2- positive breast cancer: results from a herceptin adjuvant trial. J Clin Oncol 2013; 31: 2692.
• Thurman SA, Schnitt SJ, Connolly JL, et al. Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma. Int J Radiat Oncol Biol Phys 2004; 59: 152.
• Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 1991; 19: 403.
• Foulkes WD, Grainge MJ, Rakha EA, et al. Tumor size is an unreliable predictor of prognosis in basal-like breast cancers and does not correlate closely with lymph node status. Breast Cancer Res Treat 2009; 117: 199.
• Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989; 63: 181.
• Koscielny S, Tubiana M, Lê MG, et al. Breast cancer: relationship between the size of the primary tumour and the probability of metastatic dissemination. Br J Cancer 1984; 49: 709.
• Özmen T, Mahmut Güllüoğlu B, Şevket Yegen C, Soran A. Otoimmun tiroid hastalığı ile meme kanseri prognozunun ilişkisi. Meme Sagligi Dergisi/Journal of Breast Health 2015; 11: 2.
• Cengiz O, Bozkurt B, Unal B, et al. The relationship between prognostic factors of breast cancer and thyroid disorders in Turkish women. J Surg Oncol 2004; 87: 19–25.
• Hammond M, Elizabeth H, Dowset M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 2010; 28: 2784-95.
• Freitas PAV, Vissoci GM, Pinto VM, Lajolo PP, Jorge PT. Study of the prevalence of autoimmune thyroid disease in women with breast cancer.” Endocrine Practice 2015; 22: 16-21.
• Tandon AK, Clark GM, Chamness GC, et al. HER-2/neu oncogene protein and prognosis in breast cancer. J Clin Oncol 1989; 7: 1120-8.
• Slamon DJ, Clark GM, Wong SG, et al. Humanbreast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 1987; 235: 177-82.
• Gennari A, Sormani MP, Pronzato P, et al. HER2 status and efficacy of adjuvant anthracyclines in early breast cancer: a pooled analysis of randomized trials. J Natl Cancer Inst. 2008; 100:14-20.
• Paik S, Byyant J, Park C, et al. Erb B-2 and response to doxorubicin in patients with axillary lymph node-positive, hormone receptor-negative breast cancer. J Cancer Inst 1998; 90: 1361-70.
• Slamon DJ, Godolphin W, James CA, et al. Studies of the Her-2/neu proto-oncogene in human breast and ovarian cancer. Science 1989; 244: 707.
• Pinder SE, Ellis IO, Galea M, et al. Pathological prognostic factors in breast cancer. III. Vascular invasion: relationship with recurrence and survival in a large study with long-term follow-up. Histopathology 1994; 24: 41.
• Ejlertsen B, Jensen MB, Rank F, et al. Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer. J Natl Cancer Inst 2009; 101: 729.
• Viale G, Giobbie-Hurder A, Gusterson BA, et al. Adverse prognostic value of peritumoral vascular invasion: is it abrogated by adequate endocrine adjuvant therapy? Results from two International Breast Cancer Study Group randomized trials of chemoendocrine adjuvant therapy for early breast cancer. Ann Oncol 2010; 21: 245.