Prospective clinicopathological study of breast cancer in Najaf

Table (2) Relation between age groups, family history & blood group.

Age group	Positive family history	Blood group*
		A	B	O	AB
<=50yrs	9	16	15	18	2
>50yrs	1	18	4	16	1
Total	10 (10.8)	34 (34.6)	19 (20.4)	34 (34.4)	3 (3.2)
P-value	<0.05	>0.05

* Blood group wasn’t available for 3 patients.

Numbers in parentheses represent percentage.

Table (3) Relation between age, lymph nodes status, tumour size, stage & grade

Age group	Lymph nodes*		Tumour size(cm)			Stage				Grade
	-ve	+ve	<2	2-5	>5	I	II	III	IV	I	II	III
<=50 yrs	11	40	5	34	14	2	18	31	2	7	12	34
>50 yrs	10	23	0	32	8	0	15	21	4	5	9	26
Total (100)	21 (25)	63 (75)	5 (5.4)	66 (71)	22 (23.7)	2 (2.2)	33 (35.5)	52 (55.9)	6 (6.5)	12 (12.9)	21 (22.5)	60 (64.5)
P-value	>0.05		>0.05			>0.05				>0.05

Numbers in parentheses represent percent.

*9 patients with unknown axillary status were excluded.

Age group	NO.	ER+/PR+	ER+/PR-	ER-/PR+	Total +ve	ER-/PR-	HER-2 +ve	HER-2 -ve
<=50yrs	53	13	11	9	33	17	23	20
>50 yrs	40	17	7	4	28	12	16	23
Total	93 (100)	30 (32.2)	18 (19.4)	13 (14)	61 (65.6)	29 (31.2)	39 (41.9)	43 (26.2)
P-value		>0.05					>0.05

Table (4) Relation between age groups, hormonal receptors*, and HER-2**

*Hormonal receptor status wasn’t available for 3 patients.

**HER-2 receptor status wasn’t available for 11 patients.

Numbers in parentheses represent percentage.

Table (5) Relation between the tumour grade, hormonal receptors, and HER-2

Grade	No.	Hormonal receptors			HER-2
		+ve	-ve		+ve	-ve
1	12 (100)	8 (66.7)	4 (33.3)		6 (50)	5 (41.7)
2	21 (100)	17 (81)	4 (19.1)		4 (19.1)	13 (62)
3	60 (100)	36 (60)	21 (35)		29 (48.3)	25 (41.7)
Total	93 (100)	61 (65.6)	29 (31.2)		39 (42)	43 (46.2)
P-value		>0.05			>0.05

Numbers in parentheses represent percentage.

Table (6) Relation between age groups & Nottingham Prognostic index (NPI)

Age group	No	NPI*
		Excellent 2.0-2.4	Good 2.4-3.4	Moderate 3.4-5.4	Poor >5.4	Unknown
<=50yrs	53	1	4	13	33	2
>50yrs	40	0	2	12	19	7
Total	93 (100)	1 (1.1)	6 (6.5)	25 (26.9)	52 (55.9)	9 (9.7)
P-value		>0.05

NPI couldn’t be calculated in 9 patients because their lymph node status was unknown.

Numbers in parentheses represent percentage.

Table (7) Relation between LRR, DM with Stage, Grade, Hormonal receptors, & HER-2

Type of recurrence	No.	Stage			Grade			Hormonal receptors		HER-2
		I	II	III	I	II	III	+ve	-ve	+ve	-ve
LRR patients	13	0	1	12	0	3	10	5	7	7	5
DM patients	17	1	3	13	3	1	13	8	9	12	5
LRR+DM patients	4	0	0	4	0	1	3	1	3	3	1
Total	34	1 (2.3)	4 (11.8)	29 (85.3)	3 (8.8)	5 (14.7)	26 ^(76.5)	14 (41.2)	19 (55.9)	22 (64.7)	11 (32.4)
P-value		>0.05			>0.05			>0.05		<0.05

• 
  Hormonal receptor status, HER-2 status wasn’t available for one patient with LRR.
  
• 
  Numbers in parentheses represent percentage.
  

Table (8) Relation between age groups &patients with LRR,DM or both

Type of recurrence	Age group(yrs)		P >0.05
	<=50	>50
LRR	9	4
DM	8	9
LRR+DM	1	3
Total	18 (34)	15 (37.5)

Numbers in parentheses represent percentage

Table (9) Time of development of LRR, DM or death during follow-up

	No.	1^st 6 m	7-12m	13-18m	19-24m	25-30m	31-36 m
LRR*	17	2	10	5	0	0	0
DM*	21	7	7	5	1	1	0
Death**	15	1	7	5	0	2	0

*Some patients may have developed both LRR &DM during follow up.

**Included in this category were patients with stage IV.

Table (10) Clinico-pathological features of survivours& deceased

	No	Stage				Grade			Hormonal receptors		HER-2
		I	II	III	IV	I	II	III	+ve	-ve	+ve	-ve
Disease-free survivours	53 (57)	1	29	23	##	9	15	29	41	10	12	31
Survivours with LRR*	12 (12.9)	0	1	11	##	0	3	9	6	5	6	5
Survivours with DM**	13 (14)	1	2	8	2	2	2	9	8	5	9	4
Dead patients	15 (16.1)	0	1	10	4	1	1	13 (86.7)	6	9 (60)	12 (80)	3
Total	93	2	33	52	6	12	21	60	61	29	39	43

*The status of hormonal receptors & HER-2 receptors weren’t available for one patient in this category.

** Survivours with stage IV have been included.

## Stage IV patients don’t apply into these categories.



Figure (1) Distribution of LRR



Figure (2) Distribution of DM

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دراسة مستقبلية لحالات سرطان الثدي في النجف من الناحية السريرية والنسيجية

دراسة

مقدمة الى المجلس العراقي للإختصاصات الطبيةكجزء من متطلبات

نيل زمالة المجلس العراقي للإختصاصات الطبية

في الجراحة العامة

من قبل

الدكتورة ميس سمير شمسة

بكالوريوس طب وجراحة عامة

تحت اشراف

الأستاذ المساعدالدكتور علي محمود الصائغ

زميل المجلس العراقي للإختصاصات الطبية للجراحة العامة

2008

دراسة مستقبلية لحالات سرطان الثدي في النجف من الناحية السريرية والنسيجية

الخلاصة

يشكل سرطان الثدي 32% من كل حالات سرطان الثدي المشخّصة حديثاً لدى النساء وهو السبب الرئيسي للوفاة في الأعمار40-79 عاماً. في العراق، سرطان الثدي هو اكثر السرطانات شيوعاً بين النساء حيث يشكل اكثر من 30% من كل حالات السرطان المسجلة فيهن مع وجود زيادة حادة في الاصابة عند الاصغر سناً (مقارنة بدول اخرى).

هدف وتصميم الدراسة:

دراسة بأثر مستقبلي تهدف لبيان الخصائص السريرية والنسيجية ومآل المريضات المصابات بسرطان الثدي في النجف.

المرضى والطرائق:

شملت الدراسة 93 امرأة ممن تم تشخيص اصابتهن بسرطان الثدي ومتابعتهن كل 6 اشهر خلال فترة الدراسة التي امتدت من كانون الثاني2005 وحتى آذار 2008

النتائج:

• 
  57% من نساء الدراسة كن اقل من 50 سنة.
  

• 
  شكل سرطان الثدي الأيسر59.1% وسرطان الجهة الوحشية من الثدي 52.2%.
  
• 
  77.8% من المريضات راجعن الطبيب بعد مرور 2-12 شهراً من بدء الأعراض.
  
• 
  كان حجم الورم ( 2-5) سنتمتر في71% من العينة المدروسة بينما كانت الغدد الأبطية متسرطنة في 75%.
  
• 
  كان الورم غير متمايز في 64.5% ومن المرحلة الثالثة في55.9%.
  
• 
  وجدت المستقبلات الهورمونية و مستقبلات (هير-2) في 65.6% و41.9% على التوالي.
  
• 
  شكلت الدرجة الرابعة(اكثر من5.4) من مؤشر نوتنكهام 55.9% من عينة الدراسة.
  
• 
  خلال فترة الدراسة :34 مريضة عانين من النكس ( 13 نكس موضعي و 17نكس قاصي و4 كليهما). كانت هناك علاقة بين عدم التمايز,سرطان المرحلة الثالثة, سالبية المستقبلات الهورمونية, موجبية مستقبلات (هير-2) مع حدوث النكس _غير أن العلاقة كانت ذات جدوى حسابية مع الأخير فقط.
  
• 
  جدار الصدر والكبد كانا اكثر مناطق النكس شيوعاً.
  
• 
  عند انتهاء الدراسة 57% من المريضات كن خاليات من المرض و 16.1% توفين.
  

ألإستنتاج:

تميز سرطان الثدي في العينة المدروسة ب: الاصابة بعمر مبكر نوعاً ما,التوضّع في الثدي الأيسر,تأخر التشخيص ؛ اضافة الى كثرة: الانتشار الى الغدد الابطية ,عدم التمايز,سرطان المرحلة الثالثة,مؤشر نوتنكهام من الدرجة الرابعة. كذلك كانت فترة الخلو من المرض قصيرة مع كثرة النكس في المواضع غير المحبّذة.

ظهرت في الدراسة علاقة ذات جدوى حسابية بين نكس السرطان وموجبية مستقبلات (هير-2) .

التوصيات:

• 
  زيادة حجم العينة المدروسة ومدة متابعة المرضى.
  
• 
  زيادة كفاءة البرامج التعليمية الخاصة بسرطان الثدي لتشجيع المزيد من النساء لمراجعة عيادات الثدي.
  
• 
  تعميم اجراء كشوفات المستقبلات الهورمونية ومستقبلات (هير-2) لكل مرضى سرطان الثدي.
  
• 
  توفير الكشوفات عن المستقبلات الهورمونية ومستقبلات (هير-2) في المستشفيات العامة.
  
• 
  توفير علاج (هيرسيبتين) لمرضى سرطان الثدي المتفشّي.
  
• 
  التأكيد على أهمية الفحص الدوري للثدي (كل 6 أشهر) للواتي لديهن قريبات من الدرجة الأولى مصابات بسرطان الثدي.