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Sassi F, Rekaya MB, Belarbi A, Chilla D, Mansouri N, Achouri L, Saied E, Kassa R, Kacem LB, Ouezani M, Debabeche N, Rebhi F, Rammeh S. Pathologically confirmed women's breast cancer: A descriptive study of Tunisian and Algerian series. Cancer Rep (Hoboken) 2023; 6 Suppl 1:e1818. [PMID: 37092543 PMCID: PMC10440841 DOI: 10.1002/cnr2.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most frequent malignancy among women in Tunisia and Algeria. Clinical and pathological characteristics of this cancer among these populations are not widely reported. The aim of the study was to report clinical and pathological characteristics of women's BC in a Tunisian and Algerian series. METHODS Pathologically confirmed 1089 BCs were gathered in the pathology departments of three Northern Tunisian hospitals: Tunis military, Charles Nicolle and Jendouba and in the pathology department of Alger Douera hospital between January 2015 and December 2020. Clinical and pathological findings of the two series: age, tumor size, histological type, grading according to Scarff-Bloom Richardson grading system, lymph node status at the time of diagnosis in axillary lymphadenectomy specimens and the immunohistochemical expression of estrogen and progesterone receptors (ER/PR), HER2 and Ki-67, were collected from the pathological reports. RESULTS The median age at diagnosis was 50 and 48 years in Tunisian and Algerian series, respectively (p = 0.016). The diagnosis of BC was made on surgical specimens (lumpectomy or mastectomy) in 373/491 (76%) cases of the Tunisian series and in 225/598 (37.6%) cases of the Algerian one. Median tumor size was 2.8 cm and 2.5 cm in Algerian and Tunisian series, respectively (p = 0.252). Invasive BCs not otherwise specified was observed in 440/481 (91.5%) BCs in Tunisian series and in 519/586 (88.6%) BCs in Algerian series. Axillary lymph node positive tumors were observed in 64.6% and 58.8% of Tunisian and Algerian women, respectively (p = 0.926). BCs were ER positive in 311/385 (80.8%) and 486/571 (85.1%) cases and HER2 positive in 86/283 (30.4%) and 60/385 (15.6%) cases of Tunisian and Algerian series, respectively. CONCLUSIONS In Tunisia and Algeria, BC has poor prognostic factors with large tumor sizes and high rates of lymph nodes involvement at diagnosis.
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Affiliation(s)
- Farah Sassi
- Department of Pathology, Charles Nicolle Hospital Tunis, UR17ES15, Faculté de Médecine de TunisUniversité de Tunis El ManarTunisTunisia
| | - Meriem Ben Rekaya
- Department of Pathology, Charles Nicolle Hospital Tunis, UR17ES15, Faculté de Médecine de TunisUniversité de Tunis El ManarTunisTunisia
| | - Ayed Belarbi
- Department of Pathology, Douéra Hospital, Laboratoire de Recherche polymorphisme génétique No. 18Université d'Alger 1Alger CentreAlgeria
| | - Dalia Chilla
- Department of Pathology, Douéra Hospital, Laboratoire de Recherche polymorphisme génétique No. 18Université d'Alger 1Alger CentreAlgeria
| | - Nada Mansouri
- Department of PathologyMilitary HospitalTunisTunisia
| | - Leila Achouri
- Department of Surgical OncologyRegional Hospital of JendoubaJendoubaTunisia
| | - Essia Saied
- Department of Pathology, Charles Nicolle Hospital Tunis, UR17ES15, Faculté de Médecine de TunisUniversité de Tunis El ManarTunisTunisia
| | - Reda Kassa
- Department of Pathology, Douéra Hospital, Laboratoire de Recherche polymorphisme génétique No. 18Université d'Alger 1Alger CentreAlgeria
| | - Linda Belhaj Kacem
- Department of Pathology, Charles Nicolle Hospital Tunis, UR17ES15, Faculté de Médecine de TunisUniversité de Tunis El ManarTunisTunisia
| | - Manel Ouezani
- Department of Pathology, Douéra Hospital, Laboratoire de Recherche polymorphisme génétique No. 18Université d'Alger 1Alger CentreAlgeria
| | - Nadjiba Debabeche
- Department of Pathology, Douéra Hospital, Laboratoire de Recherche polymorphisme génétique No. 18Université d'Alger 1Alger CentreAlgeria
| | - Fatima Rebhi
- Department of Pathology, Douéra Hospital, Laboratoire de Recherche polymorphisme génétique No. 18Université d'Alger 1Alger CentreAlgeria
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital Tunis, UR17ES15, Faculté de Médecine de TunisUniversité de Tunis El ManarTunisTunisia
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[Determinants of patient and health system delays for women with breast cancer in Morocco, 2013]. Rev Epidemiol Sante Publique 2015; 63:191-201. [PMID: 25975777 DOI: 10.1016/j.respe.2015.03.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 08/29/2014] [Accepted: 03/23/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Morocco, breast cancer is the first most common cancer in women. It is diagnosed in most cases at an advanced stage. Delay in diagnosis and access to treatment for breast cancer increases morbidity and mortality. The objective of this study was to determine the consultation delay (patient delay), diagnosis delay and access to treatment delay (health system delays) of women with breast cancer admitted at the National Institute of Oncology in Rabat. Factors associated with these delays were analyzed. METHODS We conducted a cross-sectional study from December 2012 to May 2013 at the National Institute of Oncology in Rabat. Two hundred eligible and consenting women were interviewed using a structured and pre-tested questionnaire. Stages I and II were identified as "early stages" and III and IV as "advanced stages". RESULTS In our population, 54% were diagnosed at an early stage of breast cancer and 46% at an advanced stage. The median total delay was 120 days (interquartile interval [IIQ]=81-202 days). The patient delay (median=65 days, IIQ=31-121) was longer than the health system delay (median=50 days, IIQ=29-77). High risk for a long total delay (more than 4 months) was observed for women who were aged over 65 years (OR=1.30, 95% CI 1.10-4.20), illiterate (OR=4.50, 95% CI 2.10-6.20), rural residents (OR=3.40, 95% CI 1.23-8.13), in a lower socioeconomic category (OR=4.75, 95% CI 1.45-15.60), without knowledge about breast self-examination (OR=5.67, 95% CI 2.65-12.15) and seen more than 2 times before diagnosis (OR=7.70, 95% CI 2.88-20.50). A long total delay increased the risk of being diagnosed at an advanced stage (OR=5.62, 95% CI 3.03-10.45). CONCLUSION Efforts should be directed to providing good information to the population at risk, better access to screening and continuing medical training to enable diagnosis and early treatment.
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BRCA genetic screening in Middle Eastern and North African: mutational spectrum and founder BRCA1 mutation (c.798_799delTT) in North African. DISEASE MARKERS 2015; 2015:194293. [PMID: 25814778 PMCID: PMC4359853 DOI: 10.1155/2015/194293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/16/2015] [Accepted: 01/26/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The contribution of BRCA1 mutations to both hereditary and sporadic breast and ovarian cancer (HBOC) has not yet been thoroughly investigated in MENA. METHODS To establish the knowledge about BRCA1 mutations and their correlation with the clinical aspect in diagnosed cases of HBOC in MENA populations. A systematic review of studies examining BRCA1 in BC women in Cyprus, Jordan, Egypt, Lebanon, Morocco, Algeria, and Tunisia was conducted. RESULTS Thirteen relevant references were identified, including ten studies which performed DNA sequencing of all BRCA1 exons. For the latter, 31 mutations were detected in 57 of the 547 patients ascertained. Familial history of BC was present in 388 (71%) patients, of whom 50 were mutation carriers. c.798_799delTT was identified in 11 North African families, accounting for 22% of total identified BRCA1 mutations, suggesting a founder allele. A broad spectrum of other mutations including c.68_69delAG, c.181T>G, c.5095C>T, and c.5266dupC, as well as sequence of unclassified variants and polymorphisms, was also detected. CONCLUSION The knowledge of genetic structure of BRCA1 in MENA should contribute to the assessment of the necessity of preventive programs for mutation carriers and clinical management. The high prevalence of BC and the presence of frequent mutations of the BRCA1 gene emphasize the need for improving screening programs and individual testing/counseling.
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Ngowa JDK, Kasia JM, Yomi J, Nana AN, Ngassam A, Domkam I, Sando Z, Ndom P. Breast Cancer Survival in Cameroon: Analysis of a Cohort of 404 Patients at the Yaoundé General Hospital. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/abcr.2015.42005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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BEN HASSEN HANEN, KALLEL IMEN, BOUCHAALA LOBNA, REBAI AHMED. ANALYSIS OF BREAST CANCER PROFILES USING BAYESIAN NETWORK MODELING. INT J BIOMATH 2013. [DOI: 10.1142/s1793524513500149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast cancer is the leading cause of cancer-related death for women in Tunisia and the prognosis of its metastasis remains a major problem for oncologists despite advances in treatment. In this work we use Bayesian networks to develop a decision support system that is based on the modeling of relationships between key signaling proteins and clinical and pathological characteristics of breast tumors and patients. Motivated by the lack of prior information on the parameters of the problem, we use the Implicit inference for the structure and parameter learning. A dataset of 84 Tunisian breast cancer patients was used and new prognosis factors were identified. The system predicts a metastasis risk for different patients by computing a score that is the joint probability of the Bayesian network using parameters estimated on the learning database. Based on the results of the developed system we identified that overexpression of ErbB2, ErbB3, bcl2 as well as of oestrogen and progesterone receptors associated with a low level of ErbB4 was the predominant profile associated with high risk of metastasis.
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Affiliation(s)
- HANEN BEN HASSEN
- Unit of Bioinformatics and Biostatistics, Center of Biotechnology of Sfax, Sfax/3038, Tunisia
| | - IMEN KALLEL
- Unit of Bioinformatics and Biostatistics, Center of Biotechnology of Sfax, Sfax/3038, Tunisia
| | - LOBNA BOUCHAALA
- Unit of Bioinformatics and Biostatistics, Center of Biotechnology of Sfax, Sfax/3038, Tunisia
| | - AHMED REBAI
- Unit of Bioinformatics and Biostatistics, Center of Biotechnology of Sfax, Sfax/3038, Tunisia
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Msolly A, Gharbi O, Ben Ahmed S. Impact of menstrual and reproductive factors on breast cancer risk in Tunisia: a case–control study. Med Oncol 2013; 30:480. [DOI: 10.1007/s12032-013-0480-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
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Contribution of epigenetic alteration of BRCA1 and BRCA2 genes in breast carcinomas in Tunisian patients. Cancer Epidemiol 2012; 36:190-7. [DOI: 10.1016/j.canep.2011.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/28/2011] [Accepted: 09/04/2011] [Indexed: 12/31/2022]
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Mahfoudh W, Bouaouina N, Ahmed SB, Gabbouj S, Shan J, Mathew R, Uhrhammer N, Bignon YJ, Troudi W, Elgaaied ABA, Hassen E, Chouchane L. Hereditary breast cancer in Middle Eastern and North African (MENA) populations: identification of novel, recurrent and founder BRCA1 mutations in the Tunisian population. Mol Biol Rep 2011; 39:1037-46. [PMID: 21603858 PMCID: PMC3249560 DOI: 10.1007/s11033-011-0829-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 05/03/2011] [Indexed: 01/20/2023]
Abstract
Germ-line mutations in BRCA1 breast cancer susceptibility gene account for a large proportion of hereditary breast cancer families and show considerable ethnic and geographical variations. The contribution of BRCA1 mutations to hereditary breast cancer has not yet been thoroughly investigated in Middle Eastern and North African populations. In this study, 16 Tunisian high-risk breast cancer families were screened for germline mutations in the entire BRCA1 coding region and exon-intron boundaries using direct sequencing. Six families were found to carry BRCA1 mutations with a prevalence of 37.5%. Four different deleterious mutations were detected. Three truncating mutations were previously described: c.798_799delTT (916 delTT), c.3331_3334delCAAG (3450 delCAAG), c.5266dupC (5382 insC) and one splice site mutation which seems to be specific to the Tunisian population: c.212 + 2insG (IVS5 + 2insG). We also identified 15 variants of unknown clinical significance. The c.798_799delTT mutation occurred at an 18% frequency and was shared by three apparently unrelated families. Analyzing five microsatellite markers in and flanking the BRCA1 locus showed a common haplotype associated with this mutation. This suggests that the c.798_799delTT mutation is a Tunisian founder mutation. Our findings indicate that the Tunisian population has a spectrum of prevalent BRCA1 mutations, some of which appear as recurrent and founding mutations.
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Affiliation(s)
- Wijden Mahfoudh
- Department of Molecular Immuno-Oncology, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Noureddine Bouaouina
- Department of Molecular Immuno-Oncology, Faculty of Medicine, 5019 Monastir, Tunisia
- Department of Radiation Oncology, CHU Farhat Hached, 4000 Sousse, Tunisia
| | - Slim Ben Ahmed
- Department of Medical Oncology, CHU Farhat Hached, 4000 Sousse, Tunisia
| | - Sallouha Gabbouj
- Department of Molecular Immuno-Oncology, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Jingxuan Shan
- Department of Genetic Medicine, Weill Cornell Medical College in Qatar, P.O. Box 24144, Doha, Qatar
| | - Rebecca Mathew
- Department of Genetic Medicine, Weill Cornell Medical College in Qatar, P.O. Box 24144, Doha, Qatar
| | - Nancy Uhrhammer
- Laboratoire Diagnostic Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France
| | - Yves-Jean Bignon
- Laboratoire Diagnostic Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France
| | - Wafa Troudi
- Laboratory of Genetics, Immunology and Human Pathology at the Faculty of Sciences of Tunis, University El Manar I, 1060 Tunis, Tunisia
| | - Amel Ben Ammar Elgaaied
- Laboratory of Genetics, Immunology and Human Pathology at the Faculty of Sciences of Tunis, University El Manar I, 1060 Tunis, Tunisia
| | - Elham Hassen
- Department of Molecular Immuno-Oncology, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Lotfi Chouchane
- Department of Genetic Medicine, Weill Cornell Medical College in Qatar, P.O. Box 24144, Doha, Qatar
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Boder JME, Elmabrouk Abdalla FB, Elfageih MA, Abusaa A, Buhmeida A, Collan Y. Breast cancer patients in Libya: Comparison with European and central African patients. Oncol Lett 2011; 2:323-330. [PMID: 22866085 DOI: 10.3892/ol.2011.245] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/14/2011] [Indexed: 11/06/2022] Open
Abstract
The present study evaluated the incidence of breast cancer in Libya and described the clinicopathological and demographic features. These features were then compared with corresponding data from patients from sub-Saharan Africa (Nigeria) and Europe (Finland). The study consisted of 234 patients with breast carcinoma, admitted to the African Oncology Institute in Sabratha, Libya, during the years 2002-2006. The pathological features were collected from pathology reports, patient histories from hospital files and the Sabratha Cancer Registry. The demographic differences between the Libyan, Nigerian and Finnish populations were prominent. The mean age of breast cancer patients in Libya was 46 years which was almost identical to that of Nigeria, but much lower than that of Finland. The Libyan breast cancer incidence was evaluated as 18.8 per 100,000 female individuals. This incidence was markedly higher in Finland, but was also high in Nigeria. Libyan and Nigerian breast cancer is predominantly of premenopausal type and exhibits unfavorable characteristics such as high histological grade and stage, large tumor size and frequent lymph node metastases. However, the histological types and histopathological risk features show similar importance regarding survival as European breast cancer cases. Survival in Libya ranks between the rates of survival in Nigeria (lowest) and Finland (highest). In conclusion, in Libya and other African countries, premenopausal breast cancer is more common than postmenopausal breast cancer. However, the opposite is true for Europe. Population differences may be involved, as suggested by the known variation, in the distribution of genetic markers in these populations. Different types of environmental impacts, however, cannot be excluded.
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Boussen H, Bouzaiene H, Ben Hassouna J, Dhiab T, Khomsi F, Benna F, Gamoudi A, Mourali N, Hechiche M, Rahal K, Levine PH. Inflammatory breast cancer in Tunisia: epidemiological and clinical trends. Cancer 2010; 116:2730-5. [PMID: 20503401 DOI: 10.1002/cncr.25175] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inflammatory breast cancer (IBC) is characterized by a peculiar geographic distribution in incidence, being described as more common in Tunisia and the region of North Africa. The authors performed a systematic review of published literature on rapidly progressing breast cancer and IBC in Tunisia and analyzed the evolution in epidemiology, clinical presentation, treatment, and therapeutic results. They collected, analyzed, and compared all the indexed Tunisian articles about rapidly progressing breast cancer and IBC since the 1970s opening of the Institut Salah Azaiz Institute in Tunis. In the 1970s, rapidly progressing breast cancer diagnosis was based on the Poussée Evolutive classification (1-3). Since the 1990s, IBC diagnosis has been based on the American Joint Committee on Cancer Poussée Evolutive 3/T4d staging. The authors compared the historical data to the most recent publications in terms of epidemiology, clinical features, treatment, and therapeutic results. The most important historical report of rapidly progressing breast cancer concerned 340 patients, representing 58.5% of a cohort of 581 breast cancer patients collected from 1969 to 1974, including 320 (55.2%) with inflammatory signs, 37(6.5%) with Poussée Evolutive 2, and 283 (48.7%) with Poussée Evolutive 3. Subsequent papers have documented a steady decrease in incidence to the current 5% to 7% T4d/IBC. Since the 1970s, Poussée Evolutive in premenopausal woman has increased from 52.5% to 75%; rural predominance has persisted. The 5-year overall survival reached 28% by the year 2000. The authors' analysis demonstrated a trend of decreasing incidence of IBC diagnoses from 50% to presently <10%, probably related to a combination of factors, including the use of more stringent criteria (Poussée Evolutive 3/T4d) for IBC diagnosis and an improvement in the socioeconomic level of Tunisia.
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Affiliation(s)
- Hamouda Boussen
- Department of Medical Oncology, Salah Azaiz Institute, Tunis, Tunisia.
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Najjar H, Easson A. Age at diagnosis of breast cancer in Arab nations. Int J Surg 2010; 8:448-52. [PMID: 20601253 DOI: 10.1016/j.ijsu.2010.05.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 04/10/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED The impression among Arab Physicians dealing with breast cancer is that it presents at an earlier age and at a more advanced stage as compared to western countries. However, the statistical data to support this impression is remarkably scarce. METHOD We performed a comprehensive literature review of reports of breast cancer in Arab countries. Articles were identified from Saudi Arabia, Bahrain, Qatar, Kuwait, Emirate, Oman, Yemen, Iraq, Syria, Jordan, Lebanon, Egypt, Libya, Algeria, Tunis, Morocco, and Sudan. RESULTS Twenty eight articles were identified and reviewed. The average age at diagnosis of breast cancer was available in 18 articles; the average age was 48 (SD = 2.8), range 43-52, median 48.5 and mode 45 years among the 7455 patients included. The median age of diagnosis of breast cancer was available in 8 articles; here, the average age was 45.4 (SD = 4.8), range 40-54.5, median 44.5 years among the 5379 patients included. The percentage of patients that were younger than 50 years old was reported in 11 articles from 8 countries and included 5144 patients; 65.5% (SD = 11) were less than 50 years old (range 49-78%, median = 66%). DISCUSSION In this literature review, the average age at presentation of breast cancer in Arab countries appears to be a decade earlier than in western countries. If this is true, this has important implications for screening and cancer management strategies in these countries, including the ideal age at which to begin screening. Adoption of Western guidelines "without critical amendment" in planning breast cancer programs will waste resources without achieving desired outcomes. Determination of the true frequency and age of onset of breast cancer in Arab women should be an important research priority.
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Affiliation(s)
- Hesahm Najjar
- Surgical Oncology Department, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
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Snoussi K, Mahfoudh W, Bouaouina N, Fekih M, Khairi H, Helal AN, Chouchane L. Combined effects of IL-8 and CXCR2 gene polymorphisms on breast cancer susceptibility and aggressiveness. BMC Cancer 2010; 10:283. [PMID: 20540789 PMCID: PMC2895614 DOI: 10.1186/1471-2407-10-283] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 06/12/2010] [Indexed: 02/05/2023] Open
Abstract
Background Interleukin-8 (IL-8/CXCL-8) is a prototype of the ELR+CXC chemokines that play an important role in the promotion and progression of many human cancers including breast cancer. We have recently showed the implication of polymorphism (-251) T/A of IL-8 gene in the susceptibility and prognosis of breast carcinoma. IL-8 acts through its CXCR1 and CXCR2 receptors. CXCR2, expressed on the endothelial cells, is the receptor involved in mediating the angiogenic effects of ELR+CXC chemokines and in particular IL-8. In the current study, we investigated the susceptibility and prognostic implications of the genetic variation in CXCR2 in breast carcinoma. We also confirmed the implication of IL-8 (-251) T/A polymorphism in a larger cohort. Finally, we combined the IL-8 and CXCR2 variant alleles and analyzed their effects in breast cancer risk and prognosis. Methods We used the allele-specific polymerase chain reaction to characterize the variation of IL-8 and CXCR2 for 409 unrelated Tunisian patients with breast carcinoma and 301 healthy control subjects. To estimate the relative risks, Odds ratios and 95% confidence intervals were calculated using unconditional logistic regression after adjusting for the known risk factors for breast cancer. Associations of the genetic marker with the rates of breast carcinoma-specific overall survival and disease-free survival were assessed using univariate and multivariate analyses. Results A highly significant association was found between the homozygous CXCR2 (+ 1208) TT genotype (adjusted OR = 2.89; P = 0.008) and breast carcinoma. A significantly increased risk of breast carcinoma was associated with IL-8 (-251) A allele (adjusted OR = 1.86; P = 0.001). The presence of two higher risk genotypes (the TA and TT in IL-8, and the TT in CXCR2) significantly increased the risk of developing breast carcinoma (adjusted OR = 4.15; P = 0.0004). The CXCR2 (+ 1208) T allele manifested a significant association with an aggressive phenotype of breast carcinoma as defined by a large tumor size, a high histological grade, and auxiliary's lymph node metastasis. A significant association between the IL-8 (-251) A allele and the aggressive form of breast carcinoma was also found. Moreover, the presence of the IL-8 (-251) A and/or the CXCR2 (+ 1208) T allele showed a significant association with a decreased overall survival and disease-free survival in breast carcinoma patients. Conclusion Our results indicated that the polymorphisms in IL-8 and CXCR2 genes are associated with increased breast cancer risk, as well as disease progress, supporting our hypothesis for IL-8 and ELR+CXC chemokine receptor (CXCR2) involvement in breast cancer pathogenesis.
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Affiliation(s)
- Kaouther Snoussi
- Laboratoire d'Immuno-Oncologie Moléculaire, Faculté de Médecine de Monastir, Université de Monastir, Monastir 5019, Tunisia.
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Breastfeeding reduces breast cancer risk: a case-control study in Tunisia. Cancer Causes Control 2010; 21:393-7. [PMID: 19921444 DOI: 10.1007/s10552-009-9471-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
Abstract
In this report, we examined the relationship between mother's breastfeeding history and her risk of breast cancer, in a case-control study in Tunisia between 2006 and 2009. About 400 breast cancer cases and 400 controls were included. Cases and controls were interviewed using a standardized structured questionnaire to obtain information on breastfeeding and other risk factors. Mean duration of breastfeeding per child was significantly associated with a reduced risk of breast cancer for women who breastfed for > 24 months per child. The OR was 0.46 (95% CI, 0.28-0.76) when compared those who breastfed for < 6 months. The test for trend was significant (p = 0.01). A significantly reduced risk of breast cancer was found for those whose lifetime duration of breastfeeding was 73-108 months (OR = 0.65, 95% CI, 0.36- 1.18) and for those who breastfed for > or = 109 months (OR = 0.42, 95% CI, 0.20-0.84). Stratification by menopausal status showed a reduced risk of breast cancer associated with a longer duration of breastfeeding for both pre- and postmenopausal women. The risk reduction was more consistent for lifetime duration of breastfeeding, the test for trend being significant for both pre- (p = 0.03) and postmenopausal (p = 0.01) women. These results support an inverse association between breastfeeding and breast cancer risk.
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Ayadi L, Khabir A, Amouri H, Karray S, Dammak A, Guermazi M, Boudawara T. Correlation of HER-2 over-expression with clinico-pathological parameters in Tunisian breast carcinoma. World J Surg Oncol 2008; 6:112. [PMID: 18945339 PMCID: PMC2577672 DOI: 10.1186/1477-7819-6-112] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 10/22/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast carcinoma is a disease with a tremendous heterogeneity in its clinical behavior. Newer prognostic factors and predictors of response to therapy are needed. The aim of this study was to evaluate the expression of HER-2, estrogen receptor (ER) and progesterone receptors (PR) in breast carcinoma and to compare it with other prognostic parameters such as histological type and grade, tumor size, patients' age, and lymph node metastases. PATIENTS AND METHODS This is a retrospective study conducted in the department of pathology at Sfax University Hospital. Confirmed 155 Cases of breast carcinoma were reviewed in the period between January 2000 and December 2004. We used immunohistochemistry to evaluate the expression of HER-2, ER, and PR receptor and Chi-square and Fisher exact test to correlate immunohistochemical findings with prognostic parameters for breast carcinoma such as patients' age, tumor size, histological type, histological grade and lymph node status. RESULTS The mean age of patients was 51.5 years, ranging from 22 to 89 years. 80 (51.6%) of the patients were below 50 years. The percentage of expression of HER-2, ER and PR was 26, 59.4, and 52.3%, respectively. HER-2 was over-expressed (3+) in 18.1% of the cases, was inversely related to ER expression (p = 0.00) and to PR expression (p = 0.048). This over-expression was also associated with a high tumor grade with marginal significance (p = 0.072). A negative correlation was noted between ER and PR expression and SBR grade (p = 0.000) and ER and age (p = 0.002). CONCLUSION HER-2 over-expression was observed in 18.1% of Tunisian breast carcinoma affecting female patients. This group presents apparently an aggressive form of breast carcinoma with high histological grade and negative ER.
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Affiliation(s)
- Lobna Ayadi
- Department of Pathology, Habib Bourguiba University Hospital, Sfax, Tunisia.
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Hachana M, Trimeche M, Ziadi S, Amara K, Gaddas N, Mokni M, Korbi S. Prevalence and characteristics of the MMTV-like associated breast carcinomas in Tunisia. Cancer Lett 2008; 271:222-30. [PMID: 18639977 DOI: 10.1016/j.canlet.2008.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Revised: 03/02/2008] [Accepted: 06/09/2008] [Indexed: 12/16/2022]
Abstract
The involvement of a retrovirus homologous to the mouse mammary tumor virus (MMTV) in the pathogenesis of human breast cancer (BC) has long been assumed, but has never been proven. Previous studies have reported the detection of MMTV-like env sequences in variable proportions that did not exceed 40% of BC cases in several countries. However, these viral sequences have been found in higher proportion (74%) in Tunisian diagnosed with BC during the seventies. This study is an attempt to evaluate the current prevalence of MMTV-like env gene in BC in Tunisian women. We used semi-nested PCR that amplify a 190-bp MMTV-like env sequence, followed by direct sequencing to screen a series of 122 cases of BC randomly selected. The findings were correlated to clinicopathological data and immunohistochemical expression status of progesterone and oestrogen receptors, HER2, and P53. Specific MMTV-like env sequences were found in 17 (13.9%) cases of breast carcinomas, whereas the same sequences were not detected in matched normal breast tissues. The presence of the viral sequences correlates inversely with progesterone receptor expression (6.8% versus 20.3%; P=0.03) and HER2 overexpression (3.1% versus 17.7%; P=0.04). This present study confirms the presence of MMTV-like env sequences in BC in Tunisian women but describes an important decrease in the prevalence of the viral sequences compared with previous studies. This reduction may be due to some changes in the virological characteristics or exposure to the virus.
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Affiliation(s)
- M Hachana
- Department of Pathology, Farhat Hached Hospital, Sousse 4000, Tunisia
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Khedhaier A, Hassen E, Bouaouina N, Gabbouj S, Ahmed SB, Chouchane L. Implication of Xenobiotic Metabolizing Enzyme gene (CYP2E1, CYP2C19, CYP2D6, mEH and NAT2) polymorphisms in breast carcinoma. BMC Cancer 2008; 8:109. [PMID: 18423013 PMCID: PMC2377277 DOI: 10.1186/1471-2407-8-109] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 04/18/2008] [Indexed: 01/03/2023] Open
Abstract
Background Xenobiotic Metabolizing Enzymes (XMEs) contribute to the detoxification of numerous cancer therapy-induced products. This study investigated the susceptibility and prognostic implications of the CYP2E1, CYP2C19, CYP2D6, mEH and NAT2 gene polymorphisms in breast carcinoma patients. Methods The authors used polymerase chain reaction and restriction enzyme digestion to characterize the variation of the CYP2E1, CYP2C19, CYP2D6, mEH and NAT2 gene in a total of 560 unrelated subjects (246 controls and 314 patients). Results The mEH (C/C) mutant and the NAT2 slow acetylator genotypes were significantly associated with breast carcinoma risk (p = 0.02; p = 0.01, respectively). For NAT2 the association was more pronounced among postmenopausal patients (p = 0.006). A significant association was found between CYP2D6 (G/G) wild type and breast carcinoma risk only in postmenopausal patients (p = 0.04). Association studies of genetic markers with the rates of breast carcinoma specific overall survival (OVS) and the disease-free survival (DFS) revealed among all breast carcinoma patients no association to DFS but significant differences in OVS only with the mEH gene polymorphisms (p = 0.02). In addition, the mEH wild genotype showed a significant association with decreased OVS in patients with axillary lymph node-negative patients (p = 0.03) and with decreasesd DFS in patients with axillary lymph node-positive patients (p = 0.001). However, the NAT2 intermediate acetylator genotype was associated with decreased DFS in axillary lymph node-negative patients. Conclusion The present study may prove that polymorphisms of some XME genes may predict the onset of breast carcinoma as well as survival after treatment.
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Affiliation(s)
- Achraf Khedhaier
- Laboratoire d'Immuno-Oncologie Moleculaire, Faculté de Médecine de Monastir, Tunisia.
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Boussen H, Bouzaiene H, Ben Hassouna J, Gamoudi A, Benna F, Rahal K. Inflammatory Breast Cancer in Tunisia: Reassessment of Incidence and Clinicopathological Features. Semin Oncol 2008; 35:17-24. [DOI: 10.1053/j.seminoncol.2007.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Charafe-Jauffret E, Mrad K, Intidhar Labidi S, Ben Hamida A, Ben Romdhane K, Ben Abdallah M, Ginestier C, Esterni B, Birnbaum D, Ben Ayed F, Xerri L, Viens P, Mezlini A, Jacquemier J. Inflammatory breast cancers in Tunisia and France show similar immunophenotypes. Breast 2007; 16:352-8. [PMID: 17360185 DOI: 10.1016/j.breast.2007.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 01/02/2007] [Accepted: 01/08/2007] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Inflammatory breast cancers (IBC) have specific immunophenotypic profiles as compared to non-inflammatory (non-IBC): combined differential expression of estrogen receptor, Ki67, E-cadherin, MUC1, and ERBB2 can be used as an IBC signature. It is thought that IBC occurs with a high frequency in Tunisia. The aim of this study is to evaluate this signature on a Tunisian series. METHODS The expression of five proteins (E-cadherin, ERBB2, estrogen receptor, Ki67, MUC1) was studied by immunohistochemistry on a consecutive series of 91 cases of IBC (T4D) treated at Tunisian Salah Azaiz Institute (ISA) and deposited in a tissue microarray (TMA). Results were compared to the same study on a series of 85 cases treated in France. RESULTS The ISA cases were characterized by a significantly younger age of patients (median: 42 years old in ISA for 53.5 in IPC, p=0.00042) and a higher frequency of invasive micropapillary pattern. None of the five parameters was expressed differentially in the two series. In non-metastatic patients, high level of proliferation (Ki67) and overexpression of ERBB2 were associated with poor outcome. CONCLUSION The IBC from Tunisia were not different from those observed in France on the basis of IHC profiles. However, the younger age of the patients suggest a specific epidemiological context that should be investigated.
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Affiliation(s)
- Emmanuelle Charafe-Jauffret
- Institut de Cancérologie de Marseille, Département d'Oncologie Moléculaire, Institut Paoli-Calmettes et UMR599 Inserm, IFR137 Marseille, France
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Snoussi K, Mahfoudh W, Bouaouina N, Ahmed SB, Helal AN, Chouchane L. Genetic variation in IL-8 associated with increased risk and poor prognosis of breast carcinoma. Hum Immunol 2006; 67:13-21. [PMID: 16698420 DOI: 10.1016/j.humimm.2006.03.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Indexed: 01/28/2023]
Abstract
Interleukin-8 (IL-8), a potent chemoattractant, has been demonstrated to contribute to human cancer progression through its potential functions as a mitogenic, angiogenic, and motogenic factor. We designed a broad study to investigate whether genetic variation in IL-8 has implications for susceptibility to and prognosis in breast carcinoma. We used the allele-specific polymerase chain reaction to characterize the variation of the IL-8 promoter region for 308 unrelated Tunisian patients with breast carcinoma and 236 healthy control subjects. Associations of the clinicopathologic parameters and the genetic marker with the rates of the breast carcinoma-specific overall survival and the disease-free survival were assessed using univariate and multivariate analyses. A significantly increased risk of breast carcinoma was associated with heterozygous IL-8 (-251) TA (OR=1.58, p=0.02) and homozygous IL-8 (-251) AA (OR=1.76, p=0.01) variants. A significant association between the IL-8 (-251) AA homozygous genotype and the aggressive phenotype of breast carcinoma as defined by the high histological grade, auxiliary's lymph node metastasis, and large tumor size was found. The IL-8 (-251) A allele manifested a significant association with decreased overall survival and disease-free survival for breast carcinoma patients. The polymorphism in the promoter region of the IL-8 gene may not only represent a marker for the increased risk of breast carcinoma but also predict the clinical outcome.
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Affiliation(s)
- Kaouther Snoussi
- Laboratoire d'Immuno-Oncologie Moléculaire, Faculté de Médecine de Monastir, Université de Monastir, 5019 Monastir, Tunisia
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Snoussi K, Strosberg AD, Bouaouina N, Ahmed SB, Helal AN, Chouchane L. Leptin and leptin receptor polymorphisms are associated with increased risk and poor prognosis of breast carcinoma. BMC Cancer 2006; 6:38. [PMID: 16504019 PMCID: PMC1397853 DOI: 10.1186/1471-2407-6-38] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 02/20/2006] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Leptin (LEP) has been consistently associated with angiogenesis and tumor growth. Leptin exerts its physiological action through its specific receptor (LEPR). We have investigated whether genetic variations in LEP and LEPR have implications for susceptibility to and prognosis in breast carcinoma. METHODS We used the polymerase chain reaction and restriction enzyme digestion to characterize the variation of the LEP and LEPR genes in 308 unrelated Tunisian patients with breast carcinoma and 222 healthy control subjects. Associations of the clinicopathologic parameters and these genetic markers with the rates of the breast carcinoma-specific overall survival (OVS) and the disease free survival (DFS) were assessed using univariate and multivariate analyses. RESULTS A significantly increased risk of breast carcinoma was associated with heterozygous LEP (-2548) GA (OR = 1.45; P = 0.04) and homozygous LEP (-2548) AA (OR = 3.17; P = 0.001) variants. A highly significant association was found between the heterozygous LEPR 223QR genotype (OR = 1.68; P = 0.007) or homozygous LEPR 223RR genotype (OR = 2.26; P = 0.001) and breast carcinoma. Moreover, the presence of the LEP (-2548) A allele showed a significant association with decreased disease-free survival in breast carcinoma patients, and the presence of the LEPR 223R allele showed a significant association with decreased overall survival. CONCLUSION Our results indicated that the polymorphisms in LEP and LEPR genes are associated with increased breast cancer risk as well as disease progress, supporting our hypothesis for leptin involvement in cancer pathogenesis.
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Affiliation(s)
- Kaouther Snoussi
- Laboratoire d'Immuno-Oncologie Moléculaire, Faculté de Médecine de Monastir, Université de Monastir, Tunisia
| | | | - Noureddine Bouaouina
- Laboratoire d'Immuno-Oncologie Moléculaire, Faculté de Médecine de Monastir, Université de Monastir, Tunisia
- Department of Cancérologie Radiothérapie CHU Farhat Hached, Sousse, Tunisia
| | - Slim Ben Ahmed
- Department of Service de Carcinologie Médicale, CHU Farhat Hached, Sousse, Tunisia
| | - A Noureddine Helal
- Unité Génome, Diagnostic Immunitaire et Valorisation, Institut Supérieur de Biotechnologie de Monastir, Université de Monastir, Tunisia
| | - Lotfi Chouchane
- Laboratoire d'Immuno-Oncologie Moléculaire, Faculté de Médecine de Monastir, Université de Monastir, Tunisia
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Charef-Hamza S, Trimeche M, Ziadi S, Amara K, Gaddas N, Mokni M, Sriha B, Yacoubi T, Korbi S. Loss of heterozygosity at the BRCA1 locus in Tunisian women with sporadic breast cancer. Cancer Lett 2005; 224:185-91. [PMID: 15914269 DOI: 10.1016/j.canlet.2004.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Revised: 10/30/2004] [Accepted: 11/02/2004] [Indexed: 10/26/2022]
Abstract
Breast cancer in Tunisia is characterized by a much higher incidence of aggressiveness compared with Western countries. The pattern of allelic loss at the BRCA1 locus in Tunisian women with breast carcinoma has not been studied. Therefore, the aim of this present preliminary study was mainly focused on loss of heterozygosity (LOH) analysis of the BRCA1 gene to determine if this tumor suppressor gene is involved in sporadic breast carcinoma among Tunisian women. We investigate allelic losses by analyzing three microsatellite markers in the BRCA1 region, in a panel of 21 human breast tumors. D17S1322 marker had the highest frequency of LOH (59%), followed by the D17S1323 (35%), and EDH-17B (20%). Collectively out of 21 informative cases 13 (62%) showed LOH at at least one BRCA1 locus. This data provides evidence that allelic loss at BRCA1 is a frequent event in sporadic breast tumorigenesis among Tunisian women, and suggests that the BRCA1 gene might play an important role as a tumor suppressor gene.
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Khedhaier A, Remadi S, Corbex M, Ahmed SB, Bouaouina N, Mestiri S, Azaiez R, Helal AN, Chouchane L. Glutathione S-transferases (GSTT1 and GSTM1) gene deletions in Tunisians: susceptibility and prognostic implications in breast carcinoma. Br J Cancer 2003; 89:1502-7. [PMID: 14562023 PMCID: PMC2394332 DOI: 10.1038/sj.bjc.6601292] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Glutathione S-transferase Theta1 and Mu1 (GSTT1 and GSTM1) are involved in the metabolism and detoxification of a wide range of potential environmental carcinogens. Conversely, they contribute to tumour cell survival by detoxification of numerous products induced by cancer therapy. The authors designed a large study to investigate the susceptibility and prognostic implications of the GSTT1 and GSTM1 gene deletions in breast carcinoma. The authors used the polymerase chain reaction to characterise the variation of the GSTT1 and GSTM1 genes in 309 unrelated Tunisian patients with breast carcinoma and 242 healthy control subjects. Associations of the clinic-pathologic parameters and the genetic markers with the rates of the breast carcinoma specific overall survival (OVS) and the disease-free survival (DFS) were assessed using univariate and multivariate analyses. A significant association was found between gene deletion of GSTT1 and the risk of early onset of breast carcinoma (OR=1.60, P=0.02). The lack of GSTT1 gene deletion was significantly associated with poor clinical response to chemotherapy (OR=2.29, P=0.03). This association was significantly higher in patients with axillary's lymph node-negative breast carcinoma (OR=12.60, P=0.005). The null-GSTT1 genotype showed a significant association with increased DFS in this selected population of patients. This association was even higher in patients carrying both null-GSTT1 and -GSTM1 genotypes. The gene deletion of GSTs may predict not only the early onset of breast carcinoma but also the clinical response to chemotherapy and the recurrence-free survival for patients with lymph node-negative breast carcinoma.
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Affiliation(s)
- A Khedhaier
- Laboratoire d'immuno-oncologie moléculaire, Faculté de Médecine de Monastir, 5019 Monastir, Tunisia
| | - S Remadi
- Laboratoire d'immuno-oncologie moléculaire, Faculté de Médecine de Monastir, 5019 Monastir, Tunisia
- Laboratoire Cytopath, Sousse Tunisia
| | - M Corbex
- Centre International de Recherche sur le Cancer (CIRC), Unité d'Epidémiologie Génétique du cancer, Lyon, France
| | - S B Ahmed
- Service de carcinologie médicale, CHU Farhat Hached, Sousse, Tunisia
| | - N Bouaouina
- Laboratoire d'immuno-oncologie moléculaire, Faculté de Médecine de Monastir, 5019 Monastir, Tunisia
- Service de carcinologie radiothérapie, CHU Farhat Hached, Sousse, Tunisia
| | - S Mestiri
- Laboratoire d'immuno-oncologie moléculaire, Faculté de Médecine de Monastir, 5019 Monastir, Tunisia
| | - R Azaiez
- Laboratoire de biologie clinique, CHU Fattouma Bourguiba Monastir, Tunisia
| | - A N Helal
- Institut Supérieur de Biotechnologie de Monastir, Monastir, Tunisia
| | - L Chouchane
- Laboratoire d'immuno-oncologie moléculaire, Faculté de Médecine de Monastir, 5019 Monastir, Tunisia
- Laboratoire d'immuno-oncologie moléculaire, Faculté de Médecine de Monastir, 5019 Monastir, Tunisia. E-mail:
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