Evaluation of prognostic factors of breast cancer in Iranian women: a systematic review

Introduction: Evaluation of hormone receptors (ER &PR), human epidermal growth factor receptor(Her2-neu), P53 protein and Ki67 and their correlation with the other prognostic factors have an important role in predicting and prognosing the breast cancer patients. The aim of this study was the evaluation of prognostic factors of breast cancer. Material and methods: articles were extracted from valid databases such as Scopus, PubMed, SID and IranMedex using keywords ( breast OR breast carcinoma OR breast cancer OR breast neoplasm ) And (Iran). Overall 22 articles about prognostic factors were selected for final review after three stages of literature review and elimination of any duplicates. Results: based on these studies, there was a significant relationship between ER and PR. Both receptors were inversely correlated with HER2 and P53. In most studies, hormone receptors were associated with low tumor grade. In contrast; Her2-neu was associated with higher tumor grade. There was nosignificant relationship between ER and Ki67. On the other hand, there was a significant relationship between PR and Her2 with Ki67 in that Ki67 was higher in patient with Her2-neu positive. Also, there was a significant relationship between the grade of tumor with Ki67 and P53. In one of the studies, lobular carcinoma was the most common type of histology in patients with expression of Ki67 and hormone receptors. In another study, medullary carcinoma had the highest Ki67 index. Other prognostic factors such as age, tumor size, pathology, vascular invasion, calcifications, nipple invasion and mitosis were not associated with hormone receptors and Her2-neu. Most of the positivehormone receptors patients were between 40-50 years old. There was no significant relationship between hormone receptors and Cathepsin D with lymph node involvement. Contrary to that, there was a significant relation between lymphnode involvement with HER2, P53, tumor grade and histopathologic type. Conclusion: the patterns of prognostic biomarkers in breast cancer and their relationship with clinicopathological characteristic and survival have wide variation in Iran. We suggest conducting larger studies with different biomarkers and longer follow-up time.

Keywords:

breast cancer , prognostic factors , hormone receptors