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Incidence and Prognostic Significance of Androgen Receptors (AR) in Indian Triple-Negative Breast Cancer (TNBC)

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Abstract

Background

Molecular sub-characterization of triple-negative breast cancer (TNBC) has great therapeutic and possibly prognostic implications. The primary aim of this study was to investigate the incidence of luminal androgen receptor (LAR) subtype of TNBC and secondary aims were sub-categorization and clinico-pathologic correlation of LAR breast cancers. Retrospective study (January 2008 and 31st of December 2018) consisting of 157 TNBC patients. Androgen receptor (AR) expression was measured by immunohistochemical analysis. One percent cutoff was set as a positive expression. Sub-categorization was done on the basis of EGFR (> 15% of tumor cells) and Ki-67 expression (low- < 11%, intermediate- 11–20%, and high- > 21%). AR expression was correlated with various clinico-pathologic features and outcomes of the patients. The incidence of AR expression in TNBC was 24.8%. Considering different thresholds of > 5%, > 10%, and > 20% immunostaining, the incidence of AR positivity was 18.4, 15.2, and 11.5% respectively. The incidence of Ki-67 (p = 0.89) and EGFR (p = 0.643) expression did not differ significantly in AR-positive and -negative TNBC. Based on EGFR expression 19, 67 and 14% patients were categorized as low, intermediate, and high risk respectively. Low-risk (p ≤ 0.001) and low-grade (p = 0.014) tumors were more likely to have > 10% AR expression. Clinico-pathological profile, response to neoadjuvant chemotherapy, disease-free survival (p = 0.458), and overall survival (p = 0.806) did not significantly differ between AR expressing and negative TNBC. On multivariate analysis, only tumor staging was a significant predictor of survival (p = 0.012) and AR expression of > 10% revealed a trend towards improved survival (p = 0.07). When considering only AR-positive TNBC, AR expression of > 10% (p = 0.038), distant metastases (p = 0.003), and EGFR status (p = 0.024) were significantly associated with survival. AR expression does not seem to very strongly correlate with prognosis in TNBC and further studies could focus more on its predictive role in deciding anti-androgen therapy.

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Funding

This study was supported by an intramural grant (A-13-PGI/IMP/80/2019) from Sanjay Gandhi Postgraduate Institute of Medical Sciences.

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Author notes

  1. Anjali Mishra and Shravan Kumar Mishra have equally contributed to this study.

Authors and Affiliations

  1. Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Anjali Mishra, Vikram Sharanappa & Gaurav Agarwal

  2. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Shravan Kumar Mishra, Narendra Krishnani & Niraj Kumari

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  1. Anjali Mishra
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Contributions

AM: (1) conception and design of the study, acquisition of data, and analysis and interpretation of data, (2) drafting the article and revising it critically for important intellectual content, (3) final approval of the version to be submitted.

SKM: (1) lab work, acquisition and analysis of data (2) revising manuscript critically for important intellectual content, (3) final approval of the version to be submitted.

VS: (1) acquisition and analysis of data (2) revising the article critically for important intellectual content, (3) final approval of the version to be submitted.

NK: (1) conception and design of the study, and analysis and interpretation of data, (2) revising the article critically for important intellectual content, (3) final approval of the version to be submitted.

NK: (1) conception and design of the study and analysis and interpretation of data, (2) revising the article critically for important intellectual content, (3) final approval of the version to be submitted.

GA: (1) the conception and design of the study (2) revising the article critically for important intellectual content, (3) final approval of the version to be submitted.

Corresponding author

Correspondence to Anjali Mishra.

Ethics declarations

The abstract based on this study was presented as poster presentation in the BSI section of the 49th World Congress of International Society of Surgery ISS/SIC, International Surgical Week 2022 (ISW 2022) held in Vienna, Austria between August 15 to 18, 2022.

Informed Consent

Informed consent was obtained from all individual participants for collection of specimens. For review consent waiver was granted by the Institute Ethics Committee. The study was approved by the Institute Ethics Committee (IEC 2019–106-IMP-EXP-9).

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The authors declare no competing interests.

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Mishra, A., Mishra, S.K., Sharanappa, V. et al. Incidence and Prognostic Significance of Androgen Receptors (AR) in Indian Triple-Negative Breast Cancer (TNBC). Indian J Surg Oncol 15, 250–257 (2024). https://doi.org/10.1007/s13193-024-01877-2

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