In addition to the specific classification name of the tumor, the size of the tumor, the clean resection of each margin, the site and number of lymph node metastases, and the presence of infiltration in the vascular lymphatic vessels and other tissues, there are some important immunological indicators that can indicate the prognosis in the postoperative pathology of breast cancer, and the analysis of these indicators can guide the treatment and estimate the prognosis. The following are common immune indicators that may be present in various hospital examinations and their interpretation for information purposes only.
ER: estrogen receptor, positive indicates a better prognosis than negative patients, the more plus signs the better.
PR: progesterone receptor, positive suggests a better prognosis than negative patients.
ER and PR are present in normal breast epithelial cells; when cells become cancerous, ER and PR appear partially and completely absent. If ER and/or PR are still retained, the growth and proliferation of the breast cancer cell is still regulated by endocrine control and is called hormone-dependent breast cancer; if ER and/or PR are absent, the growth and proliferation of the breast cancer cell is no longer regulated by endocrine control and is called non-hormone-dependent breast cancer. If both are positive, the prognosis is best. If one is positive and one is negative, estrogen positivity is better than progesterone positivity. The prognosis is not good for both negatives. Positive cases can be treated with postoperative or preoperative endocrine therapy.
Her-2 (CerbB-2): human epidermal growth factor receptor 2, a proto-oncogene. Its overexpression i.e. the presence of a plus sign indicates that the patient has a poor prognosis. It also suggests that patients are prone to axillary lymph node metastasis and possible deficiency of both of these hormone receptors. Its expression is positively correlated with breast cancer grade, lymph node metastasis and clinical stage, and the higher the expression rate, the worse the prognosis may be. However, those with more than two plus signs in Fish test have the possibility of biologically targeted therapy. That is, with trastuzumab (Herceptin).
All three of these patients are negative, and are now medically known as “triple negative” breast cancer, with a relatively poor prognosis and lack of drug treatment.
E-Cadherin: E-calcified adhesion protein is one of the transmembrane protein isoforms in the calcium adhesion protein family of molecules, which is expressed exclusively at the adherens junctions and plays an important role in maintaining the integrity, polarity, morphology and organization of epithelial cells. Its high expression indicates a good prognosis.
Ki-67index: It is a proliferative antigen that responds to cell proliferation, and its expression is associated with breast cancer development and progression, and is a poor prognostic factor. The higher the value, the worse the prognosis.
P53: It is a tumor suppressor gene and its mutation indicates poor prognosis; breast cancer cells with high P53 mutation rate have high proliferation activity, poor differentiation, high malignancy, aggressiveness and high lymph node metastasis rate.
CK5/6: It is a cytokeratin, and its expression rate increases with higher histological grade and tumor stage, and the overall positive prognosis is poor.
EGFR: Epidermal growth factor receptor, the higher the histological grade and tumor stage, the higher the expression rate, and the overall positive indicates poor clinical prognosis.
VEGF: Vascular endothelial growth factor, high expression indicates poor prognosis.
TOP-II: DNA topoisomerase II, high expression indicates higher tumor proliferation and malignancy.
PCNA: proliferating cell nuclear antigen, positive prognosis is poor.
P170: a multidrug resistance gene whose overexpression is detrimental to treatment.
nm23: a gene associated with malignant metastasis, and reduced gene expression level is a high risk factor for lymphatic metastasis of breast cancer.
Her-1: similar to Her-2 in the previous section, poorly positive.
DNA ploidy: Aneuploidy predicts tumorigenesis.
CD44V6: It is a protein, high expression suggests poor prognosis.
Ck14, Ck17 and CK7: have similar reference standards as the preceding Ck5/6.
Bcl-2: It is an apoptosis-suppressing gene, and its positive expression suggests a high degree of tumor grading and few lymph node metastases.
PS2: PS2 may be more useful than ER assay in predicting response to endocrine therapy, and PS2 expression is the best indicator of response to endocrine therapy in breast cancer.
P63: P63 gene itself is an oncogene, and P63 plays an important role in the development and progression of breast cancer; the test can provide the necessary theoretical basis for early diagnosis, timely treatment and prognosis of breast cancer.
Calponin: In the normal, hyperplastic and atypical hyperplasia groups of breast, almost all myoepithelial cells expressed P63, α-SMA and Calponin, while all glandular epithelial cells were negative for the 3 antibodies; it helps to determine infiltrating carcinoma, carcinoma in situ and atypical hyperplasia.
SMA (smooth muscle actin): smooth muscle actin is a reliable marker antibody. It disappears in a gradual progression from normal breast tissue, benign lesions to carcinoma in situ, early infiltration and invasive carcinoma.
Cyclin D1: High expression of Cyclin D1 may play an important role in the development and progression of human breast cancer. The clinical significance of high expression in breast cancer is that the expression of Cyclin D1 correlates with tumor size, TNM stage and axillary lymph node metastasis.
COX-2 (cyclooxygenase-2): The expression of COX-2 is present in breast cancer tissues.COX-2 may be a practical indicator for clinical evaluation of patient prognosis and identification of patients at high risk of postoperative recurrence.
34βE12: It is a cytokeratin, and its expression correlates with the biological index of tumor malignancy in breast cancer. Negative expression of 34βE12 in breast cancer tissues indicates poor prognosis, which can be used to judge the malignancy degree and prognosis of breast cancer.
P120 membrane: it is abnormally expressed in breast cancer tissues and correlated with E-cadherin expression, which may play an important role in the occurrence and development of breast cancer; P120 membrane is more closely related to the occurrence and development of invasive lobular carcinoma.