الفهرس 
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Abstract
The present study comprised 70 formalin fixed- paraffin-embedded tissue specimens of invasive duct carcinoma of the breast and 53 paraffin blocks of lymph node metastasis corresponding to the primary tumor which were chosen from the archives of Minia oncology center in the period between January 2013 to october 2018.
Positive cytoplasmic Twist1 expression was detected in 21.4% of cases. Cytoplasmic Twist1 expression showed statistically significant association with tumor size (p= 0.011).
Positive nuclear Twist1 expression was detected in 48.6% of cases. Nuclear Twist1 expression showed statistically significant association with tumor grade (p= 0.002), lymph node status (p= 0.049), NPI (p=0.043), ER (p=0.048), PR (p=0.016), molecular subtypes (p=0.038) and distant metastasis (p=0.001).
FoxA1 expression was detected in 45.7% of cases. A statistically significant association was found between FoxA1 expression and tumor grade (p= 0.046), lymph node status (p= 0.049) and tumor stage (p= 0.009), prognostic stage (p=0.001), NPI (p=0.042), ER (p=0.028), PR (p=0.033), Her2 (p=0.019), molecular subtypes (p=0.038) and distant metastasis (p=0.004).
A statistically significant association was found between combined expression of cytoplasmic Twist1 with FoxA1 and tumor grade (p= 0.024), tumor stage (p=0.033), prognostic tumor stage (p=0.023), molecular subtypes (p=0.019), inflammatory response (p= 0.006) and distant metastasis (p=0.001).
There was a statistically significant association was found between combined expression of nuclear Twist1 with FoxA1 and tumor grade (p= 0.036), tumor stage (p=0.016), prognostic tumor stage (p= 0.027), NPI (p= 0.011), Her2 (p=0.041) and distant metastasis (p=0.023).
Statistically significant negative correlation was found between nuclear expression of Twist1and FoxA1 (p=0.040), but insignificant correlation was found between cytoplasmic expression of Twist1 and FoxA1.
As regard cytoplasmic Twist1 expression 57.1% revealed a concordance rate between the primary tumor and corresponding lymph node metastasis. However, 42.8% changed expression of Twist1 between primary tumor and corresponding lymph node metastasis. Regarding nuclear Twist1 expression, one hundred percent of examined pairs revealed a concordance between the primary tumor and corresponding lymph node metastasis.
As regard FoxA1 expression, 96.2% revealed a concordance between the primary tumor and corresponding lymph node metastasis and 3.8% were nonconcordant.
Patient’s age (p=0.025), grade, lymph node status, LNR (p=0.004, p=0.018, p=0.022 respectively), tumor stage, prognostic stage (p=0.045, p=0.025), NPI, ER, molecular subtype, distant metastasis (p=0.002, p=0.044, p=0.012 and p=0.001 respectively) were the adverse prognostic clinical factors. In the present study, Nuclear Twist1 expression was associated with shorter DFS while FoxA1 and combined expression of cytoplasmic Twist1 and FoxA1 were associated with longer DFS.
In the multivariate analysis, patient’s age, tumor size and LNR were independent prognostic factors (p=0.037, p=0.037, p=0.006 respectively). In addition nuclear Twist1 expression and combined cytoplasmic Twist1 with FoxA1 had independent prognostic impact in patients studied (p= 0.020 and p= 0.020 respectively).