الفهرس 
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Anatomy & histology of the BreastOnly 14 pages are availabe for public view
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Abstract
To evaluate the effect of adding metformin to neoadjuvant chemotherapy in non-diabetic patients with breast cancer in relation to clinical, pathological response and survival rates. Also tolerability and possible effects on molecular pathways. Patients and methods: This study has included 76 female non-diabetic patients with invasive breast carcinoma who had been eligible for neoadjuvant chemotherapy either due to irresectability or to facilitate breast conservation. They were clinically staged (including clinical examination, bilateral mammography and ultrasound, chest X-ray, abdominal ultrasound and bone scan). Weight in Kgs and height in cm. were recorded and body mass index was calculated using the formula (BMI=Weight in Kgs/height in meters2), then they received anthracycline-based regimen and metformin 500mg, twice daily with chemotherapy and till surgery, they were evaluated for clinical response after 4 cycles, for patients who didn’t achieve the desired response for surgery they received second line taxane based chemotherapy. After surgery, pathological response was evaluated using both Miller and Satellof grading systems. The patient was then followed up regularly every 3 months by clinical examination, yearly mammography. Other investigations were done upon clinical suspicion. Results:The mean age was 44.3 years. Fifty-nine (79.7%) of them were premenopausal while 15 (20.3%) were postmenopausal. The mean weight, height and BMI were 83.1 Kgs, 157 cm and 33.4 kg/m2 respectively. The mean BMI of the patients with good clinical response was 32.8 Kg/m2 while that of the poor clinical response was 37.3 Kg/m2 (p value 0.042). Patients who had Her 2 overexpression had better clinical response than did other patients (p value 0.05).Clinically patients who presented by T2 and T3 lesions had better pathological response than did patients who presented by T4 lesion (p value 0.047).Also those who had clinical stage II had better pathological response than those who had stage III (p value 0.001).Patients who had smaller mammographic tumor sizehad better pathological response than other patients (p value 0.013).Patients who had grade III diseasehad better pathological response than did patients who had grade II disease (p value 0.057).Obese group of patients had better DFS thannormal-overweight group of patients (p value 0.001).with significant p values a group of genes were found to be overexpressed (AMPK, LKB1, TSC1/2, OCT1, PKA, APAF1, P53, P21, RPRM., PIDD,FADD and CHEK1/2) and others with reduced expression among responders (m-Tor, CYCLIN D-1,VEGF, CDK-4, CDK-1,IGF, NFKB and AKT) Conclusion: Obese group of patients had significantly better DFS when compared to normal-overweight group of patients .Metformin addition to neoadjuvant chemotherapy might explain this finding.