Expression And Significance Of P53 And VEGF In Metaplastic Carcinoma Of Breast

Objective: To investigate the expression and significance of p53 and VEGF in metaplastic carcinoma of breast(MCB).Methods:From September 2011 to January 2021,29 MCB patients were treated in Yijishan Hospital of Wannan Medical College,15 MCB patients were treated in Fuyang People’s Hospital,and 4 MCB patients were treated in Bozhou People’s Hospital,48 cases in total.The basic medical history and clinical data(sex,age,stage,etc.)of each MCB patient were collected,then the histomorphology of each case was observed and the basic pathological parameters were counted,including the diameter of the mass,tissue changes,lymph node metastasis,clinical stage,vascular invasion,nerve invasion were counted.Then the data of immunohistochemical staining of p53 and VEGF were collected and analysis in MCB and each subtype in the clinicopathologic parameters of the differences,draw conclusions.Results: All 48 cases of MCB were female,the age ranged from 43 to 82 years old,the average age was 58.04 years old.The diameter of the mass ranged from 2.2 cm to8.0 cm,the average diameter of the mass was 3.70 cm.There were 38 cases of high grade MCB(15 cases in the squamous cell carcinoma group,16 cases in the mesenchymal carcinoma Group and 7 cases in the spindle cell carcinoma group)and 10 cases of low grade MCB(6 cases in the fibromatous metaplastic carcinoma group and 4cases in the low grade adenosquamous carcinoma group).There were 15 cases with lymph node metastasis,and 33 cases without lymph node metastasis.The cases were including 20 cases with stage II A,20 cases with stage II B,5 cases with stage III B and3 cases with Stage III C.The average age of patients with low grade MCB was 65.00 years old,and the average diameter of the mass was 3.25 cm with BI-RADS category(Breast Imaging Reporting and Data System)from 3 to 5.There were no perineural invasion,vascular invasion and lymph node metastasis wih stage II A to II B.The average age of patients with high grade MCB was 57.38 years old,the average diameter of the mass was 3.75 cm,lymph node metastasis was found in 15 cases(39.47%),vascular tumor thrombus was found in 10 cases,and perineural invasion was found in 2 cases.It can be concluded that the average age of patients in high grade MCB group was lower than that in low grade MCB group.The diameter of mass,vascular invasion,perineural invasion,lymph node metastasis and clinical stage of high grade MCB group were significantly higher than that in low grade MCB group.There was no significant difference in BI-RADS category between the two groups,and the high grade MCB group was relatively higher.Imunohistochemical staining of p53 and VEGF in low grade MCB group were negative.In hige grade MCB group,22 cases(57.89%)were positive for p53,14 cases(36.84%)were positive for VEGF,among them 1 case was weakly positive,11 cases were positive,2 cases were strongly positive.It can be concluded that the expression of p53 and VEGF in high gradel MCB group was significantly higher than that in low grade MCB group(P< 0.05),the difference had a statistical significance..Although there were many subtypes in high grade MCB,the clinical data were different in each subtypes.There were 38 cases in high grade MCB group,including 15 cases of squamous cell carcinoma Subtypes(with average age of 52.22 years old),8cases with lymph node metastasis(average diameter of the mass of 4.11 cm),and 16 cases of mesenchymal carcinoma(with average age of 64.10 years old),the average diameter of the mass was 3.24 cm,5 cases with lymph node metastasis(31.25%),clinical stage from II A to III B,7 cases of spindle cell carcinoma(with average age of47.00 years old),average diameter of the mass of 3.15 cm,2 case with lymph node metastasis(28.57%),clinical stage from II A to II B.In contrast,the squamous cell carcinoma subtypes had larger average diameter and higher lymph node metastasis rates;the average age of mesenchymal carcinoma subtypes was elder and with a median lymph node metastasis rate;the average age of spindle cell carcinoma was younger,with smaller average diameter and lower lymph node metastasis rates.Imunohistochemical staining of p53 and VEGF showed that there were 15 cases in the squamous cell carcinoma group,8 cases(53.33%)were positive for p53.There were16 cases in the mesenchymal carcinoma group,10 cases(62.50%)were positive for p53,13 cases(81.25%)were positive for VEGF,1 case was weakly positive,11 cases were positive,1 case was strongly positive.In the spindle cell carcinoma subgroup,there were 7 cases,4 cases(57.14%)were positive for p53 and 1 case(14.29%)was strongly positive for VEGF.It can be concluded that p53 was highly expressed in high grade MCB,and there was no significant difference in each subtypes.VEGF was also highly expressed in high-grade MCB,especially in mesenchymal carcinoma.By comparing the clinical data with the results of immunohistochemistry,there was no significant differences of p53 in MCB,including tumor size(P= 0.2489),ultrasound score(P=0.1079),nerve invasion(P= 0.4992),vascular invasion(P=0.4694),lymph node metastasis(P= 0.3127),clinical stage(P=1.0000),ER expression(P=1.0000),PR expression(P=1.0000),Her-2 expression(P=0.0663)and Ki-67 expression(P=0.3694),the difference was statistically significant in age(P=0.0035)(P< 0.05).There was no significant differences in VEGF expression,including tumor size(P=0.5419),ultrasound score(P=0.5503),nerve invasion(P=0.1294),vascular invasion(P=1.0000),clinical stage(P=0.5419),ER expression(P=0.5520),PR expression(P=1.0000),Her-2 expression(P=0.2821)and Ki-67 expression(P=0.6295),the difference were statistically significant with age(P=0.0423)and lymph node metastasis(P=0.0047)(P < 0.05).The positive rate of p53 was positively correlated with patient’s age,while the positive rate of VEGF were positively correlated with patient’s age and lymph node metastasis.Conclusion:1.The expression rate of p53 and VEGF in low grade MCB and high grade MCB is different,it can be a useful index for differential diagnosis.2.The expression of p53 and VEGF lin MCB is of prognostic significance.