Hormonal Receptor, Human Epidermal Growth Factor and Its Association with Breast Cancer Tumor Characteristics in Albania

INTRODUCTIONEstrogen receptor (ER) and progesterone receptor (PR) expressions are the most important and useful predictive factors currently available. ER and PR are intracellular steroid hormone receptors which have received a great attention since 1986. Measurable amounts of ER and PR are found in about 50-85% of patients with breast cancer. Steroid receptor testing for ER and PR by immunohistochemistry is the established standard of care with almost 70-80% of the tumors in breast cancer being ER and/or PR positive (1). The frequency of positivity and the level of ER and PR increase with age, reaching their highest levels in postmenopausal women (2). Men have higher ER and PR expression as compared to female breast cancer patients without any association with histological prognostic markers (3).Factors that are known to be important in the prognosis of breast malignancies in individual patients include: size of the primary tumor, stage of the disease at diagnosis, hormonal receptor status, and number of lymph nodes involved with disease. A number of studies have shown the prognostic and predictive significance of ER and PR in breast cancer patients (1, 4-6). Generally, the frequency of receptor positivity is inversely correlated with HER2/neu (7, 8). Negative ER, PR have been found to be associated with higher tumour grade, larger tumour size, aggressive histopathological type, and recurrence (9, 10).Overexpression of the HER2/neu oncogene is also important event in breast cancer tumorigenesis. The HER2/neu receptor is a member of the epidermal growth factor receptor family of receptor tyrosine kinases, which are considered to be important mediators of cell proliferation and differentiation (11). It is activated in 20% to 30% of cases through amplification and overexpression of the oncogene. Overexpression of HER2/neu reflects an increased proliferative activity of the tumor. HER2/neu positivity has been reported to be a negative predictor of response to hormonal therapy, adjuvant radiotherapy, and adjuvant chemotherapy (12, 13). The determination of correct HER2/neu tumor status is criti- cally important for guiding the therapy of patients with HER2/neu positive breast cancer treated with Trastuzumab (Herceptin) (14).The objective of this study was to determine the biological differences that exist between steroid hormone receptor and epidermal growth factor receptor-2 and their association with histological prognostic markers in female breast carcinoma in Albania.MATERIALS AND METHODSThe association between breast tumor characteristics and expression of ER, PR, HER2/neu, patient's age, tumor size, lymph nodes status, and tumor grade were retrospectively evaluated in primary breast cancer patients diagnosed between January 2006 and December 2007 at "Nene Tereza" Oncologic Hospital in Tirana, treated till January 2010 - December 2011. The study population included 123 patients in the age group of 26-76 years. Among them 11 patient who had benign breast diseases and 2 male patients were excluded from the study. Only 110 histologically confirmed female breast cancer patients in different stages of the disease were selected for our study. Median follow-up for all of the patients analyzed is 48.4 month (range 36.2-64.4 months). All patient characteristics are listed in Table 1.Patients were grouped according to age 50 years. Age of the patient was taken as age rounded to the nearest figure in years at the time of biopsy/surgery of the tumor. Tumor size was classified as 5 cm and lymph nodes were grouped as 1-3, 4-9 and > 9 based on TNM staging for breast carcinoma.Factors that are known to be important in the prognosis of breast malignancies in individual patients include: size of the primary tumor, stage of the disease at diagnosis, histological grade hormonal, receptor status, and lymph nodes involved with the disease (15, 16). …