The Clinical Characteristics And The Correlatione Fators Of Prognosis Of The Basal-like Breast Carcinoma(BLBC)

With the increasing knowledge in molecular biology technology, genetic subtype classification of human breast cancers based on gene expression patterns has been recently developed, which is markedly different from traditional histology-based classification. Gene expression patterns were correlated with clinical features and applied for prognosis prediction of patients, and there are high hopes for the development of targeted molecular therapy of breast cancers. However, studies relating to gene expression in breast cancer are still in its initial stage. Nielsen diagnostic criteria used to define the breast cancer has been well accepted by the majority of scholars, the clinicopathological features of breast cancer subtypes (based on gene expression) are required to be further investigated, and their prognostic significance in human breast cancer remains controversial. Until now, most research results have come from western countries fewer studies have been performed in Asia. In China, there is only one study reported in the southern region, while no similar study on detailed epidemiological and prognostic analysis available in the north.OBJECTIVE In the present study, we utilize immuno-histochemical technology to elucidate the following important issues in a small sample size of cases of invasive breast carcinoma:1. To describe the clinical characteristics and prognosis of BLBC in a Chinese population.2. To identify molecular prognostic factors/markers for BLBC.METHODS From January 2001 to December 2006,953 female primary invasive ductal breast cancer patients were retrospectively analyzed, which had the complete paraffin section and pathological information in the pathology department of the first affiliated hospital of Dalian Medical University.1. According to Nielsen's standard,utilize the immunohistochemical technology to detect the expression of ER, HER2, CK5/6 and EGFR, find 20 cases of basal-like breast carcinoma(BLBC), contrast wit Luminal A 22 cases Luminal B 23 cases, HER2 over-expression 23 cases and normal breast-like breast carcinoma 17 cases, analyses the clinical characteristics and the prognosis of the five subtypes.2.Utilize the immunohistochemical technology to detect the expression of E-Cadherin, MMP-7, Ki-67,P53, Caveolin-1, analyses the distinct significance of the BLBC.3. Analyses the prognosis correlation factors of BLBC.RESULTS The different onset ages of Luminal A, Luminal B, BLBC, HER2 over-expression and normal breast-like breast carcinoma are 54.54,51.10,48.80,56.04,51.97 (years), BLBC is significantly lower than HER2 over-expression(P< 0.05). No significant difference was found in the remaining subtypes (P>0.05). The sizes of tumor are 3.43,3.49,2.12,2.97,3.50(cm), BLBC is significantly smaller than Luminal A, Luminai B and normal breast-like breast carcinoma (P< 0.05). The five subtypes of breast carcinoma have no difference in clinical stages, histological grades, and lymph node metastasis. But the survival rate of BLBC40%(8/12) is significantly lower than Luminal A 73.68%(14/19),Luminal B 71.43%(15/21),HER2 over-expressing type 66.67%(14/21) and normal breast-like breast carcinoma 68.75%(11/16, P=0.01, P< 0.01).The positive expression rate of E-Cadherin in Luminal A, Luminal B, HER2 over-expression and normal breast-like breast carcinoma are 100%(22/22),95.7%(22/23),80%(16/20),100%(23/23),94.1%(16/17), BLBC is significantly lower than the others. MMP-7 in Luminal A, Luminal B, HER2 over-expression and normal breast-like breast carcinoma are 40.9%(9/22),52.2%(12/23),85%(17/20),69.6%(16/23),64.7%(11/17), and is significantly higher in BLBC(P=0.037, P< 0.05). The positive expression rate of P53 are 22.7%(5/22),30.4%(7/23),60.0%(12/20), 56.5%(13/23),23.5%(4/17), and is significantly higher in BLBC(P=0.021, P< 0.05). The expression rate of Caveolin-1 are 4.8%(1/21), 13.0%(3/23),85.0%(17/20),17.4%(4/23),11.8%(2/17), and is significantly higher in BLBC than in other four subtypes(P=0.000, P< 0.01). The expression rate of Ki-67 is significantly higher in BLBC than in other four types (P=0.000, P< 0.01). The positive expressing rate of Caveolin-1 is 25.7%(27/105), CK5/6 is 20.6%(20/97). The expressions of Caveolin-1,CK5/6 and P53 are positively correlated(P< 0.01).CONCLUSION The prognosis of BLBC is the worst in genotyping breast cancer due to its high invasion and metastasis,cell proliferation and the susceptibility to mutation of P53. BLBC has the high invasive ability due to the low expression of E-Cadherin and the over expression of MMP-7 Caveolin-1.The relevant factors of prognosis of BLBC are P53,E-Cadherin, MMP-7,E-Cadherin,MMP-7,Ki-67 with mono-factor analysis, but E-Cadherin MMP-7,Caveolin-1,Ki-67 are not the important independent prognosis factors of the lower survival rate with multivariate analysis.