ABSTRACT:
Background: The most common form of cancer among women worldwide is the breast cancer. In Syria, the incidence of breast cancer is higher in coastal region, and associates with high morbidity, mortality, and enormous treatment costs. Molecular Breast Cancer Subtypes (BCSs) with different expression status of Estrogen (ER) and Progesterone (PR) receptors, and Her-2 receptor expression propose modulation of protocol of hormone-therapy in patients at high risk. Aim of the study: Classification of breast cancer patients into Breast Cancer Subtypes (BCSs) according to expression status of ER, PR receptors and Her-2 receptor, and studding their relation to other prognostic classical factors, and identification the patients at high risk who might resist to future hormone-therapy. Patients and methods: 60 female-patients diagnosed as breast cancer were selected from September 2015 until December 2016 in National hospital of Jableh (Jableh- Syria). Mean of age was 58 years. Estrogen receptor (ER) and Progesterone-receptor (PR) expression were assessed as positive or negative by Immunohistochemical analysis (IHC). Her-2 -receptor expression was confirmed by Fluorescent In-Situ Hybridation (FISH) analysis. BCSs were assessed according to hormone expression status and patients were classified into five subtypes as following: Triple Positive TP (ER+, PR +and Her-2 +), Triple Negative TN (Her-2-, ER-, PR-), Luminal A (Her-2 -, ER+ and /or PR+) Luminal B (Her-2 +, ER+ and /or PR+), and Her-2+ (ER- and PR-). Results: Triple positive breast cancer TP was presented in 48.33% of patients. 3 patients were Triple Negative TN (5%), and 19 patients were negative for ER-receptor expression (31.67%). 13 patients were luminal A and 5 patients with luminal B (8.33%). 10 patients were positive for Her-2 expression and negative for ER and PR receptor expression as fifth type (16.67%). Relation between BCSs and stage was statistically important (P. value=0.046). 31 out of 43 PR-receptor positive patients (83.78%) had lymph node >4, (P. value =0.008). Relation with age was not important and needs additional studies. Conclusion: Patients present high variety of ER-receptor, PR-receptor and Her-2 receptor expression as heterogenic subtypes breast cancer (BCSs), which propose different strategies of prevention and protocols of treatment according to subtypes diagnosed. TP was the major subtypes with pN>4 as lymph nodes metastasis. Luminal A, luminal B, TN, and Her-2 positive patties were identified as breast cancer subtypes (BCSs) at high risk.