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Prevalence of HER-2-Positive Invasive Breast Cancer: A Systematic Review from Iran
Keyhani, Elahe,Muhammadnejad, Ahad,Karimlou, Masoud Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.11
Background: The HER-2/neu gene is altered in 15-20% of breast cancer patients. Immunohistochemistry (IHC) is considered to be the most cost-effective method for HER-2 detection in many countries. Approximately 8,000 new cases of breast cancer are observed annually in Iran. The aims of this study were to conduct a systematic review of the literature on the rate of HER-2-positive breast cancer diagnosed by IHC in Iran. Methods: A systematic search of the medical literature using the Medline/PubMed, ISI and SID databases revealed articles published in the English and Persian languages evaluating HER-2-positive breast cancer in Iran. Results: From 22 studies, 3,033 patients were evaluated, of whom 1,350 were diagnosed as HER-2-positive by IHC HER-2 testing. The mean percentage of HER-2-positive patients was 44.5%, which is higher than that recorded in international statistics. Results of this meta-analysis showed a significant heterogeneity between ratios. There was a statistically significant difference between the results of pre- and post implementation of 2007 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guideline. IHC HER-2 testing has been performed in Iran for over 10 years. Similar to many other countries, before establishment of an infrastructure for IHC diagnostic tests, HER-2 testing was routinely performed in Iran. Our study showed that the statistics reported from Iran varied widely; for instance, the rate of HER-2-positive cases varied from 23.3% to 81.0%. Conclusions: Our results demonstrate that the lack of standardization and harmonization of this test have led to marked variations in breast cancer diagnosis in Iran.
Keyhani, Elahe,Muhammadnejad, Ahad,Behjati, Farkhondeh,Sirati, Fereidoon,Khodadadi, Faranak,Karimlou, Masoud,Moghaddam, Fatemeh A.,Pazhoomand, Reza Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.12
Background: Breast cancer is the most common malignancy among women in both developed and developing countries. The burden is increasing in low-income and middle-income countries (LMCs) and threatens the public health of such societies. Introduction of expensive monoclonal antibodies to cancer treatment regimens poses a real challenge in the health systems of LMCs. Despite controversy of cost-effectiveness of bevacizumab in breast cancer, some studies indicate gain of patients from this drug. The present study aimed to propose a priority setting model for administration of anti-angiogenic agents in breast cancer via assessment of tumor angiogenesis by the microvessel density (MVD) method and associations with clinicopathological characteristics (including simultaneous mutations of TP53 and HER-2 genes). Materials and Methods: Age, axillary lymph nodes status, tumor size, stage and grade, estrogen and progesterone receptors status, HER-2/neu status (by immunohistochemistry and FISH test), TP53 mutation, Ki-67 (for proliferation assay) and CD34 (for angiogenesis assay) were assessed in 111 breast cancer patients. The molecular subtype of each tumor was also determined and correlations of simultaneous mutations of HER-2 and p53 genes with angiogenesis and other clinicopathological characteristics were evaluated. Results: There were significant associations between simultaneous mutations of HER-2 and p53 genes and all other parameters except tumor size. The degree of angiogenesis in the ERBB2 subtype was greater than the others. Younger patients showed a higher angiogenesis rate rather those older than 50 years. Conclusions: Our results demonstrated that patients with simultaneous mutations of HER-2 and p53 genes, those with ERBB2 molecular subtype and also younger women (often triple negative) seem more eligible for obtaining anti-angiogenic agents. These results suggest a model for priority setting of patients with breast cancer for treatment with anti-angiogenic drugs in LMCs.
Muhammadnejad, Ahad,Keyhani, Elahe,Mortazavi, Pejman,Behjati, Farkhondeh,Haghdoost, Iraj Sohrabi Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.12
Background: Canine mammary gland tumors (CMGTs) are the most common tumor found in bitches. Changes in HER-2/neu genes in human breast cancer (HBC) lead to decrease in disease-free survival (DFS) and overall survival rate (OSR). Previous studies have demonstrated that the biological behavior of malignant mammary gland tumors (MMGTs) is similar to that of HBC. The present study aimed at evaluating the relationship between overexpression of HER-2/neu and clinicopathological features in MMGTs to represent a model of prognostic factors for HBC. Materials and Method: The clinicopathological data of 35 MMGTs were obtained. Immunohistochemical staining with HER-2, Ki-67 and CD34 markers was conducted with sections from paraffin-embedded blocks. According to standard protocols, histological type, grade, margin status, lymphovascular invasion (LVI), HER-2/neu score, proliferation rate and microvessel density (MVD) of tumors were determined and the association of HER-2/neu overexpression with these parameters was assessed statistically. Results: The IHC results showed that 12 (34.3%) cases were HER-2/neu positive. Statistical analyses indicated a significant relationship between HER-2 positivity and tumor grade (p=0.043), which also was demonstrated with cancer stage (p=0.035), tumor margin involvement (p=0.016), proliferation index (p=0.001) and MVD (p=0.001); however, there was no statistical relationship between LVI and tumor size. Overexpression of the HER-2/neu gene in MMGTs results in similar biological behavior as that of HBC; as a result, these tumors have can be considered to have important similarities in clinicopathological characteristics. Conclusions: MMGTs can be regarded as an HBC animal model. Further studies in this field would result in new treatments that could be beneficial for both dogs and humans.
( Hassan Jalaeikhoo ),( Manoutchehr Keyhani ),( Iraj Khosrownia ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Trauma patients frequently require urgent surgical procedures. They may receive many units of blood with different genetic structure so they may develop alloantibody not recognized without a high index of suspicious. They are also in need of many different antibiotics and may develop drug induced antibodies. Alloantibodies also may cause auto immune hemolytic anemia. This situation is completely different from congenital hemolytic anemia patient or other chronic anemia that needs frequent blood transfusions. Our case is a case of allo antibody complicated with drug induced hemolytic anemia and auto immune hemolytic anemia. Treatment with cautious plasmaphoresis and discontinuation of cephalosporin led to rapid clinical improvement. A rapid evaluation for allo antibody and thorough evaluation of prescribed drugs is necessary.
( Hassan Jalaeikhoo ),( Ahmad Khajeh Mehrizi ),( Manoutchehr Keyhani ),( Iraj Khosrownia ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Aplastic anemia (AA) is a rare hematological disease which is characterized by peripheral pancytopenia and hypocellular bone marrow in the absence of malignant infiltration or hyperplasia of reticulin fibers. The incidence of AA in American and European countries is around 0.23 per 100000 population per year while its incidence increases to 0.39-0.50 per 100000 population per year in Asian countries. Methods: All patients with AA who received IST at Imam Reza hospital in Tehran between May 1998 and September 2013 were identified for this retrospective study. Patients were included in this analysis if they fulfilled the criteria for AA and did not have access to HSCT. Bone marrow flow cytometry for ruling out the other causes of pancytopenia and serology examination for hepatitis A, B, C, E, Epstein barr virus (EBV) and Parvovirus B19 was carried out in all the patients. Results: Among the 63 studied patients, 29 (46%) had NSAA and 34 (54%) had SAA. Three patients had VSAA that were classified as SAA in the analysis. Twelve (19%) patients treated with ATG, CsA and danazol while 51 (81%) patients received CsA and danazol. Three patients had hepatitis associated AA; 2 of them were positive for hepatitis C and 1 of them had seronegative hepatitis. Two patients were positive for parvovirus B19. Four patients were followed after exposure to chemicals and one patient had history of taking D-penicillamine. Characteristics of studied patients are shown in Table. Conclusions: Our results indicated that patients with AA which unable to receive HSCT, could be strongly treated by IST. Also, our experience indicated that IST should not be discontinued after response to therapy in patient with both NSAA and SAA due to high risk of relapse. Low dose of CsA should be continued indefinitely.