Expresión de p53 y Bcl-2 en carcinoma ductal infiltrante de mama localmente avanzado. Su relación con el subtipo intrínseco molecular como factor pronóstico. / Expression of p53 and Bcl-2 in locally advanced infiltrating ductal carcinoma of the breast. Its relationship with the intrinsic molecular subtype as a prognostic factor.
Resumen
Resumen.
En el cáncer de mama existen factores pronósticos y predictivos que pueden afectar la evolución de las mujeres con esta enfermedad. Por tal motivo, el presente estudio tiene como objetivo determinar la expresión inmunohistoquímica (IHQ), de las proteínas p53 y Bcl-2 en el tumor primario de 285 mujeres, con diagnóstico de carcinoma ductal infiltrante de mama, en seguimiento en el Instituto de Oncología Dr. Miguel Pérez Carreño de Valencia, Venezuela. La inmunoexpresión de ambas proteínas se relacionó con los subtipos intrínsecos moleculares del cáncer de mama definidos por IHQ: Luminal A, Luminal B, HER2 y Triple Negativo (TN), la supervivencia libre de enfermedad (SLE) y la supervivencia global (SG). Los tumores p53 negativo y Bcl-2 positivo mostraron una mayor SLE y SG. En los tumores p53 negativo del subtipo Luminal A hubo una mayor SLE (p=0,005), aunque en los tumores Luminales (A y B), la SG fue mayor (p<0,05). Además, se presentó una mayor SLE en los casos Luminales y TN con expresión positiva de Bcl-2, pero sin significancia estadística. Por el contrario, hubo un efecto pronóstico significativo de la expresión de Bcl-2 en el subtipo TN, con SG media menor en comparación con la SG obtenida en los tumores con Bcl-2 positivo. Finalmente, en función de los hallazgos encontrados se concluye que la ausencia de expresión p53 y la expresión positiva de Bcl-2 son factores de buen pronóstico, con significancia estadística en los tumores Luminales y TN, respectivamente.
Abstract.
In breast cancer there are prognostic and predictive factors that can affect the evolution of women with breast cancer. For this reason, the present study aims to determine the immunohistochemical expression (IHC) of p53 and Bcl-2 proteins in the primary tumor of 285 women with a diagnosis of infiltrating ductal carcinoma of the breast under follow-up at the Dr. Miguel Oncology Institute. Pérez Carreño from Valencia, Venezuela. The immunoexpression of both proteins was related to the molecular intrinsic subtypes of breast cancer defined by IHC: Luminal A, Luminal B, HER2 and Triple Negative (TN), disease free survival (SLE) and overall survival (OS). The tumors p53 negative and Bcl-2 positive showed a higher SLE and SG. In the p53 negative tumors of the Luminal A subtype there was a higher SLE (p = 0.005), although in the Luminal tumors (A and B) the OS was higher with p <0.05. In addition, greater SLE was presented in Luminal and TN cases with positive Bcl-2 expression, but without statistical significance. On the contrary, there was a significant prognostic effect of the expression of Bcl-2 in the TN subtype, with a lower mean SG compared to the SG obtained in tumors with positive Bcl-2. Finally, based on the findings found, the absence of p53 expression and the positive expression of Bcl-2 are good prognostic factors, with statistical significance in Luminal and TN tumors, respectively.
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