Clinical and Molecular Epidemiologic Features of Inflammatory Breast Cancer in Morocco and Tunisia
AUTHORS: CE Hampton, AS Soliman, K Mrad, M Karkouri, SD Merajver
Inflammatory breast cancer (IBC), an especially lethal form of breast cancer, is associated with rapid progression and poor prognosis. Although IBC constitutes only 2% of breast cancers in the US, this proportion is higher in the region of North Africa, where 7-10% of breast cancers are IBC. Currently, clinical and pathologic criteria are used in the diagnosis IBC, including presence of edema, erythema, and tumor emboli in the dermal lymphatics. Gene expression profiles may be used to classify breast cancer into subtypes with clinical relevance. Previous research suggests the five molecular subtypes for noninflammatory breast cancer (NIBC) may also be present in IBC. Elucidating the molecular subtypes of IBC in North Africa could have implications for diagnosis and treatment of this disease in the North Africa and globally.
Confirmed cases of IBC (T4d classification) and NIBC were identified from the Institut Salah Azaiz in Tunis and the Ibn Rochd Oncology Center cancer registry in Casablanca. Clinical information was abstracted from medical records and paraffin blocks were obtained for 54 IBC and 70 NIBC cases in Tunis and Casablanca combined. Tissue microarrays were constructed from paraffin-embedded tissue cores and stained for molecular markers: ER, PR, HER2, Ki67, cytokeratin 5/6, EGFR, and ALDH. Comparisons were made between IBC and NIBC within and between countries based on clinical features and molecular subtype.
IBC cases were significantly older than NIBC cases in Morocco (p<0.001), whereas IBC cases tended to be younger and premenopausal compared to NIBC in Tunisia. Tumor emboli were significantly more frequent in NIBC cases compared to IBC cases in Tunisia, and no difference between IBC and NIBC was found in Morocco. There was no significant difference in RhoC expression in IBC compared to NIBC in Morocco or in Tunisia. The results of tumor emboli and RhoC overexpression from Tunisia and Morocco differ from our previous research studies in Egypt (significantly higher overexpression and more tumor emboli in IBC than Nnon-IBC cases)
These preliminary findings suggest the clinical and molecular characteristics of IBC may differ in Morocco and Tunisia and between countries in North Africa. Further results from this study will provide more insight on the molecular epidemiology and risk factors of IBC in North Africa.
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