BackgroundThis study was carried out to evaluate the prognostic value of KIBRA in breast cancer.MethodsThis retrospective study included breast cancer patients who sought the services of the immunohistochemistry laboratory of our unit from 2006 to 2015. Tissue microarrays were constructed and immunohistochemical staining was done to assess the KIBRA expression. The Kaplan-Meier model for univariate and Cox-regression model with backward stepwise factor retention method for multivariate analyses were used. Chi square test was used to find out the associations with the established prognostic features.ResultsA total of 1124 patients were included in the study and KIBRA staining of 909 breast cancers were available for analysis. Cytoplasmic KIBRA expression was seen in 39.5% and nuclear expression in 44.8%. Overall KIBRA–low breast cancers accounted for 41.5%. KIBRA nuclear expression was significantly associated with positive ER and PR expression. Luminal breast cancer patients who had endocrine therapy and KIBRA-low expression had a RFS disadvantage over those who were positive for KIBRA (p = 0.02). Similarly, patients who received chemotherapy and had overall KIBRA-low expression also demonstrated a RFS disadvantage compared to those who had overall positive KIBRA expression (p = 0.018). This effect of KIBRA was independent of the other factors considered for the model.ConclusionOverall low-KIBRA expression has an independent effect on the RFS and predicts the RFS outcome of luminal breast cancer patients who received endocrine therapy and breast cancer patients who received chemotherapy.

BackgroundAlthough, there are many developments in the field of management, breast cancer is still the commonest cause of cancer related deaths in women in Sri Lanka. This emphasizes the need for validation of treatment protocols that are used in Sri Lanka for managing breast cancers. There are no published papers on treatment and survival of breast cancer patients in Sri Lanka. Hence this study was designed to determine the validity of St Gallen risk categories based on the survival outcomes of breast cancer patients in Southern Sri Lanka.MethodThis retro-prospective study included all female breast cancer patients who had sought the immunohistochemistry services of our unit from May 2006 to December 2012. Patients who had neo-adjuvant chemotherapy were excluded. Patients were stratified according to the St Gallen risk categories; low-risk (LR), intermediate-risk (IR) and high-risk (HR), which is used in deciding on the adjuvant treatment. IR category was subdivided based on presence/absence of 1–3 positive-nodes (absent-IR1, present-IR2) and HR on the number of positive-nodes(1–3 lymph nodes;HR1,> 3 lymph nodes;HR2). Kaplan-Meier and Cox-regression models were used in the survival analysis.ResultsThis study included 713breast cancer patients (LR-2%, IR1–45%, IR2–10%, HR1–13%, HR2–30%). Five year breast cancer specific survival (BCSS)wasLR-100%, IR-91%, HR-66% and the recurrence free survival (RFS) was LR-85%, IR-84%, HR-65%. BCSS and RFS curves were significantly different between the three risk categories (p < 0.001).No survival difference was evident between the IR1 and IR2 (BCSS-p = 0.232, RFS-p = 0.118). HR1 and HR2 had a distinctly different BCSS (p = 0.033) with no difference in RFS (p = 0.190).ConclusionThis study validates the St Gallen risk categorization of female breast cancer patients in our setting. However, the HR includes two subsets of patients with a distinct difference in BCSS.

BackgroundCA15-3 is the most commonly used tumor marker in breast cancer. Its prognostic role has been described in the metastatic setting, but the role of pre-surgical CA15-3 in the assessment of patients with breast cancer without metastasis has not been substantiated yet.MethodologyFrom February 2014 for a 2-year period, this prospective study included all patients who were diagnosed with primary breast cancer and underwent surgery at a tertiary care hospital. The serum level of CA15-3 was assessed on a pre-surgical blood sample and later at the 3-, 6-, 9-, and 12-month follow-up by enzyme-linked immunosorbent assay. Disease-free survival (DFS) was analyzed with a Kaplan–Meier model and log-rank test.ResultsWe enrolled 195 patients (mean age ± SD 57.84 years ±13.819, range, 28–95) with breast cancer. The prevalence of elevated (≥30 U/mL) pre-surgical CA15-3 was 35.9%, and it reduced to 14.3% at 3 months after mastectomy. Pre-surgical CA15-3 had a significant association only with the size of the tumor (p=0.047). Patients who did not have elevated pre-surgical CA15-3 (≥30 U/mL) had the best short-term DFS, and it was worst when the pre-surgical CA15-3 was >100 U/mL (p=0.041).ConclusionElevated pre-surgical CA15-3 is a predictor of poor short-term DFS of patients with breast cancer without distant metastasis.

Aim/Background: Lymph node stage (LNS), tumour size and Nottingham grade (NG) are considered the most important prognostic factors of breast cancer (BC).However, NG is not yet incorporated in the long used TNM staging system which is meant to stratify BC patients into groups that are prognostically and therapeutically similar. The objective of this study was to assess the impact of NG on the BC specific survival (BCSS) and recurrence free survival (RFS) of operable BC patients. Methods: This retrospective study included a consecutive series of TNM stage I to III BC patients who had sought the services of our unit from 2006 to 2012. These patients have been treated according to standard protocols. Data were collected through follow up visits, clinic and laboratory records. Grading and scoring of estrogen receptors (ER), progesterone receptors (PR) and Her2 were done by a single investigator to eliminate inter-observer variation. Kaplan-Meier and Cox-regression models were used in the survival analysis.Results: There were 86 (12%) NG1, 338 (45%) NG2 and 318 (43%) NG3 patients with a median follow up of 39.5 months. Five-year BCSS was 94%-NG1, 80% -NG2 and 72% -NG3 ( p < 0.001). Five-year RFS was 86% -NG1, 75% -NG2 and 67% -NG 3 ( p = 0.001). Only the LNS ( p = 0.001) had an independent effect on the BCSS and RFS of NG3 patients. LNS ( p = 0.001), PR ( p = 0.004) and Her 2 ( p < 0.001) independently affected the BCSS of NG 2 patients. The same factors affected the RFS of NG2 patients except the LNS. None of the factors considered for the multivariate analysis had an effect on the BCSS or RFS of NG1 patients.NG1 patients in TNM stage I and II had 100% five-year BCSS while it was 76.7% for stage III BCs. A significant decrease in BCSS and RFS was seen with increase in NG in the sub-groups of TNM stage III ( p = 0.01 and 0.011), tumours of 2cm-5cm ( p = 0.035 and p = 0.013) and LNS3 ( p = 0.002 and p < 0.001) BC patients. Conclusions: NG categorizes BC patients into three groups with distinctly different survival outcomes. This difference is retained in the subgroups; TNM stage III, tumours of 2cm-5cm and LNS3 BCs. NG1 tumours are a homogenous group as none of the important prognostic factors affects the BCSS or the RFS. Therefore sub-categorization of TNM stage III by NG is suggested. Disclosure: All authors have declared no conflicts of interest.

Aim:To study the prognostic value of immunohistochemically detected low Claudin3 expression in breast cancers.Methods:This retrospective study included patients with breast cancer who were investigated at our unit from 2006 to 2015. Tissue microarrays were constructed, and immunohistochemical staining was done to assess the Claudin3 expression and to classify breast cancers according to the immunohistochemical surrogates for molecular classification. Kaplan-Meier model and log-rank test were used for recurrence-free survival and breast cancer–specific survival analysis.Results:Of the 853 patients, overall low expression of Claudin3 was seen in 18.4%. Recurrence-free survival of patients with overall low Claudin3 breast cancers was poor in luminal A (P = .006) and luminal B (Her2−) (P = .009) subtypes compared with those who had Claudin3 expression in each group.Conclusions:Assessment of Claudin3 expression by immunohistochemistry is suggested for luminal A and luminal B (Her2−) subtypes to identify patients with poor prognosis.