Epidemiological profile and distribution of prognostic factors in invasive breast cancer among Algerian women Artykuł oryginalny
##plugins.themes.bootstrap3.article.sidebar##
Opublikowane:
wrz 22, 2021
Słowa kluczowe:
breast cancer, epidemiology, biomarkers, immunohistochemistry, prognostic
##plugins.themes.bootstrap3.article.main##
Abstrakt
Although the widespread of early screening and advanced medical therapies, the breast cancer incidence rate continues to rise among Algerian women. This retrospective study investigated mammary lesions’ epidemiological profile and histopathological characteristics and evaluated primary invasive breast cancer prognostic factors. We found that the incidence of breast cancer increases in middle- aged women between 40 and 60 years. Scarff Bloom Richardson grade II predominates in invasive breast cancer samples. In this study, molecular profiling shows that 82.1% of invasive tumours are hormone receptor-positive. A significant correlation is observed between the age of the patient and the SBR grade (p = 0.001) and with the hormone receptor expression (p = 0.001). In addition, the tumour grade is significantly correlated to oestrogen and progesterone receptor expression (p = 0.000; p = 0.000, respectively). Twenty-two per cent of cases were human epidermal growth factor receptor 2-positive. The Ki-67 proliferation index is expressed in 91% of breast cancer patients and was significantly associated with Scarff Bloom Richardson grade (p = 0.030), the progesterone receptor expression (p = 0.029) and with human epidermal growth factor receptor 2-positivity (p = 0.023). Primary breast cancer with a high grade is more frequent (31%) in young women under 40 years old, presenting 17% of our population. In summary, breast cancer patients in Algeria develop an unfavourable profile. Immunohistochemistry assay has played a pivotal role in assessing breast cancer predictive biomarkers improving the tumour behaviour and response to treatment.
Pobrania
Dane pobrania nie są jeszcze dostepne
##plugins.generic.paperbuzz.metrics##
##plugins.generic.paperbuzz.loading##
##plugins.themes.bootstrap3.article.details##
Jak cytować
1.
Elbasyouni A, Saadi L, Baha A. Epidemiological profile and distribution of prognostic factors in invasive breast cancer among Algerian women. OncoReview [Internet]. 22 wrzesień 2021 [cytowane 22 listopad 2024];11(4 (44):95-101. Dostępne na: https://journalsmededu.pl/index.php/OncoReview/article/view/1422
Numer
Dział
CARDIO-ONCOLOGY
Utwór dostępny jest na licencji Creative Commons Uznanie autorstwa – Użycie niekomercyjne 4.0 Międzynarodowe.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
Bibliografia
1. Benarba B, Meddah B, Hamdani H. Cancer incidence in North West Algeria (Mascara) 2000-2010: results from a population-based cancer registry. EXCLI Journal. 2014; 15.
2. Azamjah N, Soltan-Zadeh Y, Zayeri F. Global Trend of Breast Cancer Mortality Rate: A 25-Year Study. Asian Pac J Cancer Prev. 2019; 20(7): 2015-20.
3. Mei J, Zhao J, Fu Y. Molecular classification of breast cancer using the mRNA expression profiles of immune related genes. Sci Rep. 2020; 10(1): 4800.
4. Negro G, Aschenbrenner B, Brezar SK et al. Molecular heterogeneity in breast carcinoma cells with increased invasive capacities. Radiol Oncol. 2020; 54(1): 103-18.
5. Tfaily MA, Nassar F, Sellam L-S et al. Calin G (ed). miRNA expression in advanced Algerian breast cancer tissues. PLoS ONE. 2020; 15(2): e0227928.
6. Turashvili G, Brogi E. Tumor Heterogeneity in Breast Cancer. Front Med. 2017; 4: 227.
7. Makki J. Diversity of Breast Carcinoma: Histological Subtypes and Clinical Relevance. Clin Med Insights Pathol. 2015; 8: 23-31. http://doi.org/10.4137/CPath.S31563.
8. Harbeck N, Penault-Llorca F, Cortes J et al. Breast cancer. Nat Rev Dis Primers. 2019; 5(1): 66.
9. Tsang JYS, Tse GM. Molecular Classification of Breast Cancer. Adv Anat Pathol. 2019; 27(1): 9.
10. Viale G. The current state of breast cancer classification. Ann Oncol. 2012; 23: x207-10.
11. Goldhirsch A, Wood WC, Coates AS et al. Strategies for subtypes – dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011; 22(8): 1736-47.
12. Shah T, Guraya S. Breast cancer screening programs: Review of merits, demerits, and recent recommendations practiced across the world. J Microsc Ultrastruct. 2017; 5(2): 59.
13. Testa U, Castelli G, Pelosi E. Breast Cancer: A Molecularly Heterogenous Disease Needing Subtype-Specific Treatments. Med Sci. 2020; 8(1): 18.
14. Sinn HP, Kreipe H. A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition. Breast Care. 2013; 8(2): 149-54.
15. Qureshi A, Pervez S. Allred scoring for ER reporting and it’s impact in clearly distinguishing ER negative from ER positive breast cancers. J Pak Med Assoc. 2010; 60(5): 5.
16. Marchiò C, Annaratone L, Marques A et al. Evolving concepts in HER2 evaluation in breast cancer: Heterogeneity, HER2-low carcinomas and beyond. Seminars in Cancer Biology. 2020; S1044579X20300493.
17. Vincent-Salomon A. Classification morphologique des carcinomes mammaires de type rare. Lett Cancérol. 2013; XXII(4).
18. Atif N. Role of immunohistochemical markers in breast cancer and their correlation with grade of tumour, our experience. Int Clin Pathol J. 2018;6(3):141–145. https://doi.org/10.15406/icpjl.2018.06.00175. (access: 13.06.2020).
19. Barzaman K, Karami J, Zarei Z et al. Breast cancer: Biology, biomarkers, and treatments. Int Immunopharmacol. 2020; 84: 106535.
20. Gradishar WJ, Anderson BO, Balassanian R et al. Breast Cancer Version 2.2015. J Natl Compr Canc Netw. 2015; 13(4): 28.
21. Guiu S, Charon-Barra C, Vernerey D et al. Coexpression of androgen receptor and FOXA1 in nonmetastatic triple-negative breast cancer: ancillary study from PACS08 trial. Future Oncol. 2015; 11(16): 2283-97.
22. Bansal C, Sharma A, Pujani M et al. Correlation of hormone receptor and human epidermal growth factor Receptor-2/neu expression in breast cancer with various clinicopathologic factors. Indian J Med Paediatr Oncol. 2017; 38(4): 483.
23. Danforth DN. Molecular profile of atypical hyperplasia of the breast. Breast Cancer Res Treat. 2018; 167(1): 9-29.
24. Vogel VG. Epidemiology of Breast Cancer. In: The Breast [Internet]. Elsevier; 2018: 207-18.e4 (access: 4.07.2020).
25. Mufudza C, Sorofa W, Chiyaka ET. Assessing the Effects of Estrogen on the Dynamics of Breast Cancer. Comput Math Methods Med. 2012; 2012: 1-14.
26. Blows FM, Driver KE, Schmidt MK et al. Subtyping of Breast Cancer by Immunohistochemistry to Investigate a Relationship between Subtype and Short and Long Term Survival: A Collaborative Analysis of Data for 10,159 Cases from 12 Studies. PLoS Med. 2010; 7(5): e1000279.
27. Purdie CA, Quinlan P, Jordan LB et al. Progesterone receptor expression is an independent prognostic variable in early breast cancer: a population-based study. Br J Cancer. 2014; 110(3): 565-72.
28. Carroll JS, Hickey TE, Tarulli GA et al. Deciphering the divergent roles of progestogens in breast cancer. Nat Rev Cancer. 2017; 17(1): 54-64.
29. McGuire A, Brown J, Malone C et al. Effects of Age on the Detection and Management of Breast Cancer. Cancers. 2015; 7(2): 908-29.
30. AlZaman A, Mughal S, AlZaman Y et al. Correlation between hormone receptor status and age, and its prognostic implications in breast cancer patients in Bahrain. SMJ. 2016; 37(1): 37-42.
31. Al-Nuaimy WMT, Ahmed AH, Al-Nuaimy HAA. Immunohistochemical Evaluation of Triple Markers (ER, PR and HER-2/neu) in Carcinoma of the Breast in the North of Iraq. DJMLD. 2015; 1(1): 001-9.
32. Sofi GN, Sofi JN, Nadeem R et al. Estrogen Receptor and Progesterone Receptor Status in Breast Cancer in Relation to Age, Histological Grade, Size of Lesion and Lymph Node Involvement. Asian Pac J Cancer Prev. 2012; 13(10): 5047-52.
33. Kuukasjärvi T, Kononen J, Helin H et al. Loss of estrogen receptor in recurrent breast cancer is associated with poor response to endocrine therapy. JCO. 1996; 14(9): 2584-9.
34. Saedi HS, Nasiri M-RG, ShahidSales S et al. Comparison of Hormone Receptor Status in Primary and Recurrent Breast Cancer. Iran J Cancer Prev. 2012; 5(2): 5.
35. Mahmoud MM, Mahmoud M. Breast Cancer in Kirkuk City, Hormone Receptors Status (Estrogen and Progesterone) and Her-2/Neu and Their Correlation with Other Pathologic Prognostic Variables. J Med. 2014; 6(1): 14.
36. Furrer D, Paquet C, Jacob S et al. The Human Epidermal Growth Factor Receptor 2 (HER2) as a Prognostic and Predictive Biomarker: Molecular Insights into HER2 Activation and Diagnostic Implications. In: Lemamy GJ (ed). Cancer Prognosis [Internet]. IntechOpen. 2018 (access: 10.06.2020).
37. Hsu JL, Hung MC. The role of HER2, EGFR, and other receptor tyrosine kinases in breast cancer. Cancer Metastasis Rev. 2016; 35(4): 575-88.
38. Cesca MG, Vian L, Cristóvão-Ferreira S et al. HER2-positive advanced breast cancer treatment in 2020. Cancer Treat Rev. 2020; 88: 102033.
39. Gaibar M, Beltrán L, Romero-Lorca A et al. Somatic Mutations in HER2 and Implications for Current Treatment Paradigms in HER2-Positive Breast Cancer. J Oncol. 2020; 2020: 1-13.
40. Yábar A, Meléndez R, Muñoz S et al. Effect of Ki-67 assessment in the distribution of breast cancer subtypes: Evaluation in a cohort of Latin American patients. Mol Clin Oncol. 2017; 6(4): 503-9.
41. Nahed AS, Shaimaa MY. Ki-67 as a prognostic marker according to breast cancer molecular subtype. Cancer Biol Med. 2016; 13(4): 496.
42. Keyhani E, Muhammadnejad A, Karimlou M. Prevalence of HER-2-Positive Invasive Breast Cancer: A Systematic Review from Iran. Asian Pac J Cancer Prev. 2012; 13(11): 5477-82.
43. Somasundaram K, Mukherjee G, Vaidyanathan K et al. ErbB-2 expression and its association with other biological parameters of breast cancer among Indian women. Indian J Cancer. 2010; 47(1): 8.
44. Guedouar Y, Bekkouche Z, Ben Ali F et al. Évaluation phénotypique des sous-types moléculaires en carcinologie mammaire dans une population de l’Ouest algérien. J Afr Cancer 2014; 6: 150–158. https://doi.org/10.1007/s12558-014-0318-1.
45. Mansouri H, Mnango LF, Magorosa EP et al. Ki-67, p53 and BCL-2 Expressions and their Association with Clinical Histopathology of Breast Cancer among Women in Tanzania. Sci Rep. 2019; 9(1): 9918.
46. Nishimura R, Osako T, Okumura Y et al. Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer. Exp Ther Med. 2010; 1(5): 747-54.
47. Kermani TA, Kermani IA, Faham Z et al. Ki-67 status in patients with primary breast cancer and its relationship with other prognostic factors. Biomed Res Ther. 2019; 6(2): 2986-91.
48. Varga Z, Li Q, Jochum W et al. Ki-67 assessment in early breast cancer: SAKK28/12 validation study on the IBCSG VIII and IBCSG IX cohort. Sci Rep. 2019; 9(1): 13534.
49. Kurbel S, Dmitrović B, Marjanović K et al. Distribution of Ki-67 values within HER2 & ER/PgR expression variants of ductal breast cancers as a potential link between IHC features and breast cancer biology. BMC Cancer. 2017; 17(1): 231.
50. Elkablawy M, Albasri A, Mohammed R et al. Ki67 expression in breast cancer. Correlation with prognostic markers and clinicopathological parameters in Saudi patients. SMJ. 2016; 37(2): 137-41.
51. Chen H, Zhou M, Tian W et al. Coleman WB (ed). Effect of Age on Breast Cancer Patient Prognoses: A Population-Based Study Using the SEER 18 Database. PLoS ONE. 2016; 11(10): e0165409.
52. Chen G, Wu D, Guo W et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020; 130(5): 2620-9.
53. Anstine LJ, Keri R. A new view of the mammary epithelial hierarchy and its implications for breast cancer initiation and metastasis. J Cancer Metastasis Treat 2019; 5: 50.
54. Yang Z, Yang M, Yu W et al. Molecular mechanisms of estrogen receptor β-induced apoptosis and autophagy in tumors: implication for treating osteosarcoma. J Int Med Res. 2019; 47(10): 4644-55.
2. Azamjah N, Soltan-Zadeh Y, Zayeri F. Global Trend of Breast Cancer Mortality Rate: A 25-Year Study. Asian Pac J Cancer Prev. 2019; 20(7): 2015-20.
3. Mei J, Zhao J, Fu Y. Molecular classification of breast cancer using the mRNA expression profiles of immune related genes. Sci Rep. 2020; 10(1): 4800.
4. Negro G, Aschenbrenner B, Brezar SK et al. Molecular heterogeneity in breast carcinoma cells with increased invasive capacities. Radiol Oncol. 2020; 54(1): 103-18.
5. Tfaily MA, Nassar F, Sellam L-S et al. Calin G (ed). miRNA expression in advanced Algerian breast cancer tissues. PLoS ONE. 2020; 15(2): e0227928.
6. Turashvili G, Brogi E. Tumor Heterogeneity in Breast Cancer. Front Med. 2017; 4: 227.
7. Makki J. Diversity of Breast Carcinoma: Histological Subtypes and Clinical Relevance. Clin Med Insights Pathol. 2015; 8: 23-31. http://doi.org/10.4137/CPath.S31563.
8. Harbeck N, Penault-Llorca F, Cortes J et al. Breast cancer. Nat Rev Dis Primers. 2019; 5(1): 66.
9. Tsang JYS, Tse GM. Molecular Classification of Breast Cancer. Adv Anat Pathol. 2019; 27(1): 9.
10. Viale G. The current state of breast cancer classification. Ann Oncol. 2012; 23: x207-10.
11. Goldhirsch A, Wood WC, Coates AS et al. Strategies for subtypes – dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011; 22(8): 1736-47.
12. Shah T, Guraya S. Breast cancer screening programs: Review of merits, demerits, and recent recommendations practiced across the world. J Microsc Ultrastruct. 2017; 5(2): 59.
13. Testa U, Castelli G, Pelosi E. Breast Cancer: A Molecularly Heterogenous Disease Needing Subtype-Specific Treatments. Med Sci. 2020; 8(1): 18.
14. Sinn HP, Kreipe H. A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition. Breast Care. 2013; 8(2): 149-54.
15. Qureshi A, Pervez S. Allred scoring for ER reporting and it’s impact in clearly distinguishing ER negative from ER positive breast cancers. J Pak Med Assoc. 2010; 60(5): 5.
16. Marchiò C, Annaratone L, Marques A et al. Evolving concepts in HER2 evaluation in breast cancer: Heterogeneity, HER2-low carcinomas and beyond. Seminars in Cancer Biology. 2020; S1044579X20300493.
17. Vincent-Salomon A. Classification morphologique des carcinomes mammaires de type rare. Lett Cancérol. 2013; XXII(4).
18. Atif N. Role of immunohistochemical markers in breast cancer and their correlation with grade of tumour, our experience. Int Clin Pathol J. 2018;6(3):141–145. https://doi.org/10.15406/icpjl.2018.06.00175. (access: 13.06.2020).
19. Barzaman K, Karami J, Zarei Z et al. Breast cancer: Biology, biomarkers, and treatments. Int Immunopharmacol. 2020; 84: 106535.
20. Gradishar WJ, Anderson BO, Balassanian R et al. Breast Cancer Version 2.2015. J Natl Compr Canc Netw. 2015; 13(4): 28.
21. Guiu S, Charon-Barra C, Vernerey D et al. Coexpression of androgen receptor and FOXA1 in nonmetastatic triple-negative breast cancer: ancillary study from PACS08 trial. Future Oncol. 2015; 11(16): 2283-97.
22. Bansal C, Sharma A, Pujani M et al. Correlation of hormone receptor and human epidermal growth factor Receptor-2/neu expression in breast cancer with various clinicopathologic factors. Indian J Med Paediatr Oncol. 2017; 38(4): 483.
23. Danforth DN. Molecular profile of atypical hyperplasia of the breast. Breast Cancer Res Treat. 2018; 167(1): 9-29.
24. Vogel VG. Epidemiology of Breast Cancer. In: The Breast [Internet]. Elsevier; 2018: 207-18.e4 (access: 4.07.2020).
25. Mufudza C, Sorofa W, Chiyaka ET. Assessing the Effects of Estrogen on the Dynamics of Breast Cancer. Comput Math Methods Med. 2012; 2012: 1-14.
26. Blows FM, Driver KE, Schmidt MK et al. Subtyping of Breast Cancer by Immunohistochemistry to Investigate a Relationship between Subtype and Short and Long Term Survival: A Collaborative Analysis of Data for 10,159 Cases from 12 Studies. PLoS Med. 2010; 7(5): e1000279.
27. Purdie CA, Quinlan P, Jordan LB et al. Progesterone receptor expression is an independent prognostic variable in early breast cancer: a population-based study. Br J Cancer. 2014; 110(3): 565-72.
28. Carroll JS, Hickey TE, Tarulli GA et al. Deciphering the divergent roles of progestogens in breast cancer. Nat Rev Cancer. 2017; 17(1): 54-64.
29. McGuire A, Brown J, Malone C et al. Effects of Age on the Detection and Management of Breast Cancer. Cancers. 2015; 7(2): 908-29.
30. AlZaman A, Mughal S, AlZaman Y et al. Correlation between hormone receptor status and age, and its prognostic implications in breast cancer patients in Bahrain. SMJ. 2016; 37(1): 37-42.
31. Al-Nuaimy WMT, Ahmed AH, Al-Nuaimy HAA. Immunohistochemical Evaluation of Triple Markers (ER, PR and HER-2/neu) in Carcinoma of the Breast in the North of Iraq. DJMLD. 2015; 1(1): 001-9.
32. Sofi GN, Sofi JN, Nadeem R et al. Estrogen Receptor and Progesterone Receptor Status in Breast Cancer in Relation to Age, Histological Grade, Size of Lesion and Lymph Node Involvement. Asian Pac J Cancer Prev. 2012; 13(10): 5047-52.
33. Kuukasjärvi T, Kononen J, Helin H et al. Loss of estrogen receptor in recurrent breast cancer is associated with poor response to endocrine therapy. JCO. 1996; 14(9): 2584-9.
34. Saedi HS, Nasiri M-RG, ShahidSales S et al. Comparison of Hormone Receptor Status in Primary and Recurrent Breast Cancer. Iran J Cancer Prev. 2012; 5(2): 5.
35. Mahmoud MM, Mahmoud M. Breast Cancer in Kirkuk City, Hormone Receptors Status (Estrogen and Progesterone) and Her-2/Neu and Their Correlation with Other Pathologic Prognostic Variables. J Med. 2014; 6(1): 14.
36. Furrer D, Paquet C, Jacob S et al. The Human Epidermal Growth Factor Receptor 2 (HER2) as a Prognostic and Predictive Biomarker: Molecular Insights into HER2 Activation and Diagnostic Implications. In: Lemamy GJ (ed). Cancer Prognosis [Internet]. IntechOpen. 2018 (access: 10.06.2020).
37. Hsu JL, Hung MC. The role of HER2, EGFR, and other receptor tyrosine kinases in breast cancer. Cancer Metastasis Rev. 2016; 35(4): 575-88.
38. Cesca MG, Vian L, Cristóvão-Ferreira S et al. HER2-positive advanced breast cancer treatment in 2020. Cancer Treat Rev. 2020; 88: 102033.
39. Gaibar M, Beltrán L, Romero-Lorca A et al. Somatic Mutations in HER2 and Implications for Current Treatment Paradigms in HER2-Positive Breast Cancer. J Oncol. 2020; 2020: 1-13.
40. Yábar A, Meléndez R, Muñoz S et al. Effect of Ki-67 assessment in the distribution of breast cancer subtypes: Evaluation in a cohort of Latin American patients. Mol Clin Oncol. 2017; 6(4): 503-9.
41. Nahed AS, Shaimaa MY. Ki-67 as a prognostic marker according to breast cancer molecular subtype. Cancer Biol Med. 2016; 13(4): 496.
42. Keyhani E, Muhammadnejad A, Karimlou M. Prevalence of HER-2-Positive Invasive Breast Cancer: A Systematic Review from Iran. Asian Pac J Cancer Prev. 2012; 13(11): 5477-82.
43. Somasundaram K, Mukherjee G, Vaidyanathan K et al. ErbB-2 expression and its association with other biological parameters of breast cancer among Indian women. Indian J Cancer. 2010; 47(1): 8.
44. Guedouar Y, Bekkouche Z, Ben Ali F et al. Évaluation phénotypique des sous-types moléculaires en carcinologie mammaire dans une population de l’Ouest algérien. J Afr Cancer 2014; 6: 150–158. https://doi.org/10.1007/s12558-014-0318-1.
45. Mansouri H, Mnango LF, Magorosa EP et al. Ki-67, p53 and BCL-2 Expressions and their Association with Clinical Histopathology of Breast Cancer among Women in Tanzania. Sci Rep. 2019; 9(1): 9918.
46. Nishimura R, Osako T, Okumura Y et al. Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer. Exp Ther Med. 2010; 1(5): 747-54.
47. Kermani TA, Kermani IA, Faham Z et al. Ki-67 status in patients with primary breast cancer and its relationship with other prognostic factors. Biomed Res Ther. 2019; 6(2): 2986-91.
48. Varga Z, Li Q, Jochum W et al. Ki-67 assessment in early breast cancer: SAKK28/12 validation study on the IBCSG VIII and IBCSG IX cohort. Sci Rep. 2019; 9(1): 13534.
49. Kurbel S, Dmitrović B, Marjanović K et al. Distribution of Ki-67 values within HER2 & ER/PgR expression variants of ductal breast cancers as a potential link between IHC features and breast cancer biology. BMC Cancer. 2017; 17(1): 231.
50. Elkablawy M, Albasri A, Mohammed R et al. Ki67 expression in breast cancer. Correlation with prognostic markers and clinicopathological parameters in Saudi patients. SMJ. 2016; 37(2): 137-41.
51. Chen H, Zhou M, Tian W et al. Coleman WB (ed). Effect of Age on Breast Cancer Patient Prognoses: A Population-Based Study Using the SEER 18 Database. PLoS ONE. 2016; 11(10): e0165409.
52. Chen G, Wu D, Guo W et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020; 130(5): 2620-9.
53. Anstine LJ, Keri R. A new view of the mammary epithelial hierarchy and its implications for breast cancer initiation and metastasis. J Cancer Metastasis Treat 2019; 5: 50.
54. Yang Z, Yang M, Yu W et al. Molecular mechanisms of estrogen receptor β-induced apoptosis and autophagy in tumors: implication for treating osteosarcoma. J Int Med Res. 2019; 47(10): 4644-55.