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American Journal of Applied Sciences
Year: 2009  |  Volume: 6  |  Issue: 3  |  Page No.: 445 - 448

HER2 Protein Overexpression in Infiltrating Ductal Carcinoma of the Breast Associated with Lymph Node Involvement

Adrienne Pratti Lucarelli, Maria Marta Martins, Vilmar Marques Oliveira, Maria Antonieta Longo Galvao, Joao Marcelo Guedes, Jose Francisco Rinaldi, Tsutomo Aoki and Sebastiao Piato    

Abstract: The current study compares the rates of overexpression of the HER2 protein in stage II ductal carcinoma of breast in patients with lymph-node involvement. The research material was tissue sections obtained from the primary tumor of 28 patients with lymph-node involvement. The technique used to detect the protein was immunohistochemistry. The overexpression of HER2 protein occurred in 33.3% of lymph node-positive patients. Subsequently, the lymph-node metastases population was divided into two subgroups: one subgroup having involvement of up to three lymph nodes and the second subgroup with the involvement of four or more lymph-nodes. In the first group the level of HER2 overexpression was 7.7% and in the second subgroup the HER2 overexpression was 63.6%. The difference was statistically significant.

Table 1 the results are presented concerning the association of the HER2 protein expression with the number of affected axillary lymph nodes in the 28 patients of the two groups. Recoding of the protein expression is presented in Table 2.

Table 1: HER2 expression in the primary tumors of the 28 patients with affected axillary lymph nodes
p = 0.038

Table 2: HER2 expression in the primary tumors of the 28 patients with affected lymph nodes (excluding patients with +2 classification)
p = 0.004

Based on the statistical analysis, we can affirm that there was an association between the variables, indicating that there is a greater percentage of strong expression among the patients with more than three involved lymph nodes.

With the goal of improving the prognosis of women affected by breast cancer, several researchers have aimed to develop new therapeutic strategies, especially those that are based on the overexpression of the HER2 protein on the primary tumor cells[16-18]. In 1998, trastuzumab was approved by the Food and Drug administration of the USA for the treatment of breast cancer metastasis in patients with HER2 overexpression. Several clinical trials have evidenced that patients affected by breast cancer, in which the neoplastic cells of the primary tumor present high immunoexpression (+3), benefit from the adjuvant treatment using this medication[17,19].

In associating the number of lymph nodes in the 24 women with affected axillae (4 patients were excluded having a +2 expression), it was verified that the rate of overexpression (+3) was of 7.7% in the subgroup with up to three affected lymph nodes by metastasis and of 63.6% in those with more than three lymph nodes. Concerning the first subgroup, our results are in accordance with those obtained by Tandon et al.[10], yet our rate was considerably more elevated in relation to the second.

As demonstrated, other authors also obtained rates of overexpression of HER2 in the primary tumor of women affected by breast cancer proportional to the affected axillary lymph nodes[7,9,20]. The existence of the association between HER2 overexpression with the number of involved axillary lymph nodes observed by several authors and by our research team in the present study seems to indicate that this protein plays a relevant role in breast cancer dissemination.

The results obtained in this study, in addition to those observed by other authors that performed similar investigations evidenced the advantage of researching the presence of HER2 protein overexpression in neoplastic cells of the primary breast cancer lesions, regardless of the axillary lymph node state. Once this information becomes available, the doctor will be able to indicate with greater precision the use of more intensive adjuvant therapy, aiming to achieve better survival rates in women affected by breast cancer.

CONCLUSION

In comparing the group of patients with axillary metastasis, it was verified that the HER2 overexpression was significantly greater in subgroup with four or more affected lymph nodes in comparison to those with only three affected lymph nodes.

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