IMPACT OF PTEN, ESTROGEN RECEPTOR (ER), AND PROGESTERONE RECEPTOR (PR) EXPRESSION ON PROGNOSIS IN DIFFERENT HISTOLOGICAL GRADES OF BREAST CARCINOMA IN A LOCAL POPULATION

Abstract

Background: Breast carcinoma remains the fourth globally as well as locally most common cancer and the second cause of cancer-related deaths in the world. The relevance of PTEN, Estrogen Receptor (ER), and Progesterone Receptor (PR) are significant in analyzing the prospects in dealing with breast carcinoma.

Objective: The objective of the study was to determine the immunohistochemical staining of PTEN, ER and PR in breast carcinoma and the relationship between these staining and histological grades and prognosis among the local population.

Method: This retrospective cohort study was performed over five years in the department of Pathology MBBS-MC Mirpur AJK. This study compared 200 female patients in the primary invasive breast carcinoma stage. After the experimentation, clinical and pathological information was gathered and PTEN, ER, and PR levels were determined with IHC. clinical and histopathological characteristics were retrieved from patients’ records and analyzed, Clinical data included patient’s age, size of the tumor, STATUS of lymph nodes and the treatment administered. Tumor grade and tumor stage details were compiled from patients’ histopathological reports. IHC analysis of PTEN, ER, and PR proteins was done on tissue sections of formalin-fixed paraffin-embedded samples.

Results: The mean age of the patients was 52 years. PTEN was expressed in 65% of cases, with significant (p < 0. 001) variations across histological grades: it was observed that 80 % of the patients in grade I, 60 % of the patients in grade II, and 40 % of the patients in grade III. ER and PR were positive in 70% and 60% of cases, respectively. These were 85%, 65%, and 40% for ER having (p-value < 0. 001) and 75%, 55%, and 35% with (p-value < 0. 001) for PR in grades I, II, and III, respectively. Thus, 5-year overall survival (OS) was significantly higher in patients with PTEN-positive tumors, 85% versus 60% in patients with PTEN-negative tumors (log rank test, p < 0. 001). ER-positive and PR-positive patients had 5-year OS 88% and 84%, respectively, whereas ER-negative and PR-negative patients were 50% and 52%, respectively (p < 0. 001 for both).

Conclusion: It was also established that PTEN, ER, and PR expression decreased as the histological grade of breast carcinoma increased. Elevated levels of positive biomarkers proved to have significant improved overall survival and disease-free survival.

Keywords: Breast Carcinoma, PTEN, Estrogen Receptor, Progesterone Receptor, Prognosis, Histological Grades, Immunohistochemistry