Menopoz Durumunun Moleküler Meme Kanseri Alt Tipleri İle İlişkisi.

Yıl 2022, Cilt: 4 Sayı: 2, 56 - 60, 01.07.2022

Şeref Dokcu Mehmet Ali Çaparlar Özhan Çetindağ Musluh Hakseven Aydan Eroğlu

https://doi.org/10.38175/phnx.1059347

Öz

Amaç
Meme kanseri, oldukça farklı biyolojik davranışlar sergileyen ve birçok genomik iz taşıyan heterojen bir hastalık grubudur. Cinsiyet hormonlarına bağımlılığı da menopoz durumu ile ilişkisini belirler. İmmünohistokimyasal (IHC) belirteçlerle yapılan reseptör analizine ve Ki67 düzeyine göre beş moleküler alt tipe ayrılır. Bu çalışmada, tedavi stratejilerimizi belirlemeye yardımcı olmak için menopoz durumu ile bu moleküler alt tipler arasındaki ilişkiyi incelemeyi amaçladık.
Gereç ve yöntem
2012-2020 yılları arasında Onkoloji Kliniğimizde meme kanseri nedeniyle ameliyat edilen 250 hastanın veri tabanı geriye dönük olarak incelendi. Hastalar menopoz durumlarına ve klinikopatolojik özelliklerine göre gruplandırıldı. İstatistiksel analiz %95 güven aralığında yapıldı ve 0,05'ten düşük bir p değeri istatistiksel olarak anlamlı kabul edildi.
Bulgular
Hastalar menopoz durumlarına göre %44.8 (n=112) premenopozal ve %65.2 (n=138) postmenopozal olarak 2 gruba ayrıldı. Yapılan istatistiksel analizde premenopozal kadınlarda Ki67 düzeyi yüksekti (p=0.015). Ayrıca premenopozal kadınlarda görülen tümörler ER negatifliği (p=0.024) ve yüksek histolojik derece (grade3) (p=0.015) ile ilişkiliydi. Postmenopozal kadınlarda luminal alt tip (luminal A, luminal B) meme kanserlerinin, premenopozal kadınlarda ise luminal olmayan alt tiplerin (HER2+, TNBC) daha sık izlendiği bulundu.
Sonuç
Yakın gelecekteki kişiselleştirilmiş tedavi stratejilerini belirleyecek olan genomik karmaşa hala aydınlatılmayı beklemektedir. Bu bilinmez doğayı anlamamıza yarayacak randomize, prospektif, multidisipliner ve popülasyon tabanlı çalışmalara hala ihtiyaç vardır.

Anahtar Kelimeler

Meme kanseri, İmmunohistokimyasal analiz, Moleküler alt tip, Menopozal durum

Relationship of Menopausal Status with Molecular Breast Cancer Subtypes

Öz

Objective
Breast cancer is a heterogeneous disease group that exhibits quite different biological behaviors and bear many genomic traces. Its dependence on sex hormones also determines its relationship with menopausal status. It is divided into five molecular subtypes according to receptor analysis and Ki67 level with immunohistochemical (IHC) markers. This study aimed to examine the relationship between the menopausal status and these molecular subtypes to help determine our treatment strategies.
Material and Method
The database of 250 patients who were operated on for breast cancer in our Oncology Clinic between 2012 and 2020 was retrospectively analyzed. The patients were grouped by their menopausal status and clinicopathological characteristics. Statistical analysis was made at a 95% confidence interval, and a p-value lower than 0.05 was considered statistically significant.
Results
The patients were divided into 2 groups by their menopausal status as 44.8% (n = 112) as premenopausal and 65.2% (n=138) as postmenopausal. In the statistical analysis performed, the level of Ki67 was high in premenopausal women (p=0.015). Also, tumors seen in premenopausal women were associated with ER negativity (p=0.024) and high histological grade (grade3) (p=0.015). It was found that luminal subtype (luminal A, luminal B) breast cancers were observed more frequently in postmenopausal women and non-luminal subtypes (HER2+, TNBC) were observed more frequently in premenopausal women.
Conclusion
The genomic complexity that will determine personalized treatment strategies soon remains to be clarified. There is still a need for randomized, prospective, multidisciplinary, and population-based studies to help us understand this unknown nature.

Anahtar Kelimeler

Breast cancer, İmmunohistochemical analysis, Molecular subtype, Menopausal status

Kaynakça

• El Saghir NS, Seoud M, Khalil MK, Charafeddine M, Salem ZK, Geara FB, et al. Effects of young age at presentation on survival in breast cancer. BMC Cancer. 2006;6:1–8.
• Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, et al. Personalizing the treatment of women with early breast cancer: Highlights of the St Gallen international expert consensus on the primary therapy of early breast Cancer 2013. Ann Oncol. 2013;24(9):2206–23.
• Eroglu A, Cicek E. Meme kanserinde moleküler alt tiplere göre cerrahi tedavi yaklaşımları. Yeni Tıp Derg. 2014;31:83–7.
• Ogawa Y, Hai E, Matsumoto K, Ikeda K, Tokunaga S, Nagahara H, et al. Androgen receptor expression in breast cancer: Relationship with clinicopathological factors and biomarkers. Int J Clin Oncol. 2008;13(5):431–5.
• Wiechmann L, Sampson M, Stempel M, Jacks LM, Patil SM, King T, et al. Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 2009;16(10):2705–10.
• Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, et al. Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(4):290–303.
• Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, 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(20):3324–30.
• Keegan THM, DeRouen MC, Press DJ, Kurian AW, Clarke CA. Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res. 2012;14(2):R55.
• Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. J Am Med Assoc. 2006;295(21):2492–502.
• Albergaria A, Ricardo S, Milanezi F, Carneiro V, Amendoeira I, Vieira D, et al. Nottingham Prognostic ındex in triple-negative breast cancer: A reliable prognostic tool? BMC Cancer. 2011;11.
• Lin NU, Vanderplas A, Hughes ME, Theriault RL, Edge SB, Wong YN, et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer. 2012;118(22):5463–72.
• Faheem M, Mahmood H, Khurram M, Qasim U, Irfan J. Estrogen receptor, progesterone receptor, and Her 2 Neu positivity and its association with tumour characteristics and menopausal status in a breast cancer cohort from northern Pakistan. Ecancermedicalscience. 2012;6(1):1–8.
• Li CY, Zhang S, Zhang XB, Wang P, Hou GF, Zhang J. Clinicopathological and prognostic characteristics of triple- negative breast cancer (TNBC) in chinese patients: A retrospective study. Asian Pacific J Cancer Prev. 2013;14(6):3779–84.
• Wang K, Ren Y, Li H, Zheng K, Jiang J, Zou T, et al. Comparison of clinicopathological features and treatments between young (≤40 years) and older (>40 years) female breast cancer patients in West China: A retrospective, epidemiological, multicenter, case only study. PLoS One. 2016;11(3):1–14.
• Kocaöz S, Korukluoǧlu B, Parlak Ö, Doǧan HT, Erdoǧan F. Comparison of clinicopathological features and treatments between pre- And postmenopausal female breast cancer patients - A retrospective study. Prz Menopauzalny. 2019;18(2):68–73.
• Susan Cleator 1, Wolfgang Heller RCC. Triple-negative breast cancer: therapeutic options. Lancet Oncol. 2007;8(1):235–44.