الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is a heterogeneous disease with five subtypes. It is a major contributor of disease morbidity and mortality both in Egypt and globally. Axillary nodal status is the most significant prognostic factor with the others being tumour size, grade, age at diagnosis and histological type. ER, PR and Her 2 both a predictive and prognostic impact.
Due to its evolving nature especially when recurrent and metastatic, new biomarkers are required. The androgen receptor, insulin-like growth factor 1 receptor and tumour infiltrating lymphocytes are some of the biomarkers which have been found to have both a predictive and prognostic value in breast cancer in the last two decades.
The present work was executed retrospectively to correlate these three biomarkers with clinico-pathological parameters and survival data in non-metastatic BC. To achieve this aim we retrospectively collected clinicopathologic and survival data for 105 BC patients treated at Alexandria Main University Hospitals from January 2010 to December 2016.
The patients’ formalin fixed paraffin-embedded blocks were then retrieved and analyzed for AR and IGF-1R expression via immunohistochemistry and TILs through hematoxylin and eosin staining.
In our study, 59% of patients were AR positive which was slightly below the level reported in BC. AR immunoreactivity was associated with negative Her 2 status and negative lymphovascular invasion, a shorter DFS but no impact on the OS. Multiple prior studies have shown that a positive AR is associated with favourable clinicopathologic parameters in breast cancer including low grade, positive ER and PR and negative Her 2 and a good prognosis.
To our knowledge, this was the first study assessing the presence of IGF-1R in female Egyptian patients. It was immunoreactive in 51.4% of our patients and this corresponded with reports studying its expression in BC. A positive IGF-1R was significantly associated with postmenopausal status, carcinoma in situ and negative extra-nodal extension but no impact on both DFS and OS. A positive IGF-1R in BC has been associated with different parameters, some favourable and some unfavorable plus a differential impact on survival in BC.
All our patients expressed stromal TILs ranging from 5% to 95%. TIL expression was significantly associated with a tumour size less than 5 centimeters, invasive lobular carcinoma, carcinoma in situ, negative LVI and longer survival. Using the classification of the International TILs Working Group, 71.4% of our patients had an intermediate TIL expression. 10% of our patients had lymphocyte predominant breast cancer (LPBC). Unlike most reports, stromal TILs had no impact on the DFS and OS when we correlated with the TILs intensity and when we compared the LPBC and the non-LPBC arms. However, TILs predicted a statistically significant impact on OS in non-luminal BC.
Univariate analysis of factors found to have a negative effect on DFS were AR expression and Her 2 positivity. On multivariate analysis, only AR positivity was found to be significant. For OS, univariate an