Hrybach S. Breast cancer in postmenopausal women: clinical, pathological and molecular biological features, significance of metabolic syndrome

The thesis is devoted to the actual problem of oncology, namely the study of clinical and molecular and biological features of breast cancer (BC) which are associated with metabolic syndrome, and reasoning of their importance for the evaluation of the aggressiveness of the disease course in patients of postmenopausal age. The analysis of clinical and anamnesis data revealed that the incidence of metabolic syndrome (MS) in BC patients of postmenopausal age is 58.9%. The majority of postmenopausal patients had the overweight and the obesity of grade II (26.4% and 24.8%, respectively), while the obesity of I and III grades were diagnosed in 20.1% and 13.2%, respectively, and only 15.5 % of patients were of normal weight. The BMI analysis of in patients with MS (MS+) and without MS (MS-) showed that among MS+ patients the number of patients with obesity I-III degree was 84.6%, and among MS- patients was 57.5%. Significant changes in the lipid profile were observed in MS+ patients compared to MS- patients without and reference values of TG level (2.01±0.21 mmol/l), LDL (3.85±0.14 mmol/l), very LDL (0.91±0.04 mmol/l) and total cholesterol 6.75±0.44 mmol/l. Analysis of clinical, molecular and biological features in BC patients of postmenopausal age with MS indicates more aggressive tumor properties.64.5% of those patients with MS had bigger tumor sizes (>2.5 cm), and 47.4% of MS+ patients had increased number of affected of regional lymph nodes by metastasis (5-8). In patients with MS, the basal-like molecular subtype predominated (31.6% and 39.4%, respectively). The incidence of CD44+ tumors was significantly higher in BC patients with MS compared to patients without MS (p <0.05). The tendency for additional increase in the incidence of CD44+ tumors under the augmentation of the BC stage was determined. In the presence of MS, the number of CD44-positive tumors was the highest (33.3%).It was shown that the incidence of CD44+ tumors was significantly higher in patients with lymph node metastases than in patients without metastatic lesions (p<0.01). Among BC patients with metastases in 1-8 regional lymph nodes, the proportion of those who had the CD44+ tumors was significantly higher (33.3%) if they were MS+ than in the group with no signs of MS (25.9%). The overall 5-year and relapse-free 3-year survivals of BC patients with metabolic syndrome were significantly lower in patients with CD44 expression in tumor cells (p<0.05).