Retrospective Study Of Combined 5-IHC In Predicting Axillary Lymph Node Metastasis In Hormone Receptor Positive Breast Cancer

Objective: Breast cancer currently has the highest incidence among women.It was originally a local disease.During development,it can metastasize to lymph nodes and distant organs.The most common is breast cancer axillary lymph node metastasis.Of the axillary lymph node metastases,the vast majority of patients die from the metastases rather than the breast cancer itself.Lymph node metastasis is the most common factor related to the prognosis of malignant tumors.Within 3 years after clinical diagnosis of breast cancer,distant metastases occur in about 10-15% of breast cancer patients.However,it is not uncommon for metastases to occur 10 years or more after the initial diagnosis.The heterogeneity of metastasis makes it difficult not only to assess the risk of metastasis,but also to formulate treatment strategies for the disease.Assessing axillary lymph node status in breast cancer patients at the time of initial diagnosis has been a challenge,and we assess the risk of axillary metastases in patients with breast cancer-related risk indicators.Clinical Assessment of axillary lymph node(ALN)metastasis mainly relies on imaging or pathological parameters as preliminary evaluation modality.Patients with possibility of ALN metastasis are often subject to SLNB or ALND.The aim of this study was to evaluate whether combined five proliferation biomarkers by immunohistochemistry(5-IHC)is better than Ki-67 alone for prognostic prediction of ALN metastasis in the absence of molecular profiling.Methods: A total of 571 breast cancer patients were selected from March 2010 to June 2016,all of whom were admitted to the breast surgery department of the first affiliated hospital of China medical university(Shenyang).571 early breast cancer(BC)patients were retrospectively reclassified based on molecular subtypes.Expression of 5 breast cancer-related genes(Cathepsin L2,CyclinB1,STK 15,Survivin and Ki-67)from Oncotype DX were reviewed by IHC.The correlation of single or combined 5-IHC with ALN metastasis in breast cancer patients and their predictive value for ALN metastasis were evaluated in three subtype cancer patients.Results: Although both Ki-67 index and Ki-67 IHC score have good prediction value in HR+/HER2-breast cancer patients(AUC=0.617 for Ki-67 index and AUC=0.642 for Ki-67 IHC score),the combined 5-IHC score is more powerful to differentiate N0 and N1 in these patients(AUC=0.800,p< 0.001)with sensitivity of 83.7% and specificity of 63%.However,combined 5-IHC and at least 4 proliferation biomarkers could not distinguish the risk of ALN metastasis in HER2+ and triple-negative BC.Conclusion: Our data suggested that combined 5-IHC score of five proliferation biomarkers(Cathepsin L2,CyclinB1,STK 15,Survivin and Ki-67)might be a more powerful tool than Ki-67 alone to predict ALN metastasis in HR+/HER2-BC,which need to be confirmed in well-designed prospective studies in the future.