Prognostic Significance Of Nuclear Factor Kappa B (P65) Among Breast Cancer Patients In Cape Coast Teaching Hospital

Abstract

Breast cancer is known to be aggressive among Africans including Ghanaian women with high mortality. Nuclear factor kappa B (NF-kB), a transcription marker has been linked to malignant tumors including breast cancer. However, the underlying molecular mechanism remains unclear with no known published data on NF-kB prognostic significance among breast cancer patients in Ghana or any other African country. This study aimed to assess the prognostic significance of NF-kB (p65) expression and its association with various clinicopathological features in breast cancer patients at Cape Coast Teaching Hospital (CCTH). A cross-sectional study design and purposive sampling procedure were used to obtain breast cancer tissues from 90 breast cancer patients and normal breast tissues from 15 individuals without breast cancer for NF-kB (p65) examination by immunohistochemical technique and data was analyzed by SPSS version 25. The study revealed that NF-kB (p65) was expressed in 86.7% of breast cancer tissues with a significant relationship to tumor grade, proliferation index (Ki67) and molecular subtype. In terms of highlevel expression, tumor grade 3 was about 10 times that of grade 1 (54.2% versus 5.1%), and Ki67 > 20 was 79.7% compared to 20.3% for Ki67 ≤ 20. Triplenegative breast cancer patients had 49.1% overexpression of NF-kB (p65) compared to 17% and 25.4% for luminal A and luminal B respectively. Only 8.5% high expression of NF-kB (p65) was seen in HER 2-enriched cases. There was no strong association between NF-kB (p65) expression and other clinicopathological parameters such as age, hormonal receptors, laterality, lymphovascular invasion, perineural invasion, pathological lymph node stage, pathological tumor stage and HER 2. The AUC predictive value of NF-kB (p65) was 0.919 with a sensitivity of 83% and specificity of 84% (p <0.0001). This first study in Ghana (Africa) shows that NF-kB (p65) is highly expressed among breast cancer patients in CCTH-Ghana and has a link to tumor grade, Ki67 and molecular subtypes. NF-kB (p65) might affect the prognosis of breast cancer patients. To assess the role and linkage of NF-kB (p65) expression as a potential prognostic marker and therapeutic target, additional studies with a bigger sample size and in vitro experiments are required.