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The impact of nottinghem prognostic index (NPI) on the occurrence of relapses in her-2 / NEU positive breast cancer

Author: 
DzengisJasar, Snezhana Smichkoska, Katerina Kubelka-Sabit, VanjaFilipovski and Gordana Petrushevska
Subject Area: 
Health Sciences
Abstract: 

Introduction: Immunohistochemical detection of Human epidermal growth factor (HER-2 / neu) is necessary in the evaluation of breast cancer. According to data in the literature, 10-30% of breast cancers show expression of this marker, which applies as unfavorable prognostic factor. Therefore, it is important in the selection of patients who will benefit from adequate treatment with Herceptin. Aim of this study is to determine the impact of clinical, histopathological and immunohistochemical parameters and NPI- Nottingham prognostic index on the occurrence of relapses in HER-2 / neu positive breast cancer. Material and Methods: In this retrospective study, 174 patients were included. All of the patients were previously treated from primary breast cancer, and were analyzed in histopathological laboratory in Acibadem / Sistina clinical Hospital in the period from June 2007 to June 2010. Beside the analysis of clinical and histopathological parameters as well as the NPI, additional immunohistochemicaltests were evaluated in order to determine the HER-2 / neu status, the Ki67 proliferative index, and the expression of the protein product of the tumor suppressor gene p53. During the follow-up period (42 to 80 months) relapses were observed in 38 patients (21.8%). Results: The age of patients ranged from 28-83 (average 55.48, +10.0) years. Lymphnode metastases were found in 99 (57%) patients. The tumor was poorly differentiated in 70 patients (40%). Immunohistochemical expression of HER-2 / neu was observed in 33 patients (19%) and relapses of the disease were present in 13 of them (40%). In 30 of the 33 HER2 / neu-positive patients (90%), NPI was higher than 3.4. Despite this association, the expression of HER-2 / neu was correlated with tumor diameter, lymph node status, mitotic index, degree of histological differentiation, lymph-vascular invasion, stage of the disease and the expression of p53 protein product and proliferative index Ki67 (p<0.05). Conclusion: The score of theNottingham prognostic index higher than 3.4 which included the tumor size, lymphonodal status and degree of histological differentiation of the tumor, is an excellent parameter in evaluating the course of the disease in the HER-2 / neu positive breast cancers compared to the occurrence of relapses.

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