High Proliferation Predicts Pathological Complete Response to Neoadjuvant Chemotherapy in Early Breast Cancer

被引:38
|
作者
Alba, Emilio [1 ]
Lluch, Ana [2 ]
Ribelles, Nuria [1 ]
Anton-Torres, Antonio [3 ]
Sanchez-Rovira, Pedro [4 ]
Albanell, Joan [5 ,6 ]
Calvo, Lourdes [7 ]
Lopez Garcia-Asenjo, Jose Antonio [8 ]
Palacios, Jose [9 ]
Ignacio Chacon, Jose [10 ]
Ruiz, Amparo [11 ]
De la Haba-Rodriguez, Juan [12 ]
Segui-Palmer, Miguel A. [13 ]
Cirauqui, Beatriz [14 ]
Margeli, Mireia [14 ]
Plazaola, Arrate [15 ]
Barnadas, Agusti [16 ]
Casas, Maribel [17 ]
Caballero, Rosalia [17 ]
Carrasco, Eva [17 ]
Rojo, Federico [18 ]
机构
[1] Virgen de la Victoria Univ Hosp, Malaga, Spain
[2] Valencia Univ Hosp, Valencia, Spain
[3] Miguel Servet Univ Hosp, Zaragoza, Spain
[4] Jaen Hosp Complex, Jaen, Spain
[5] Inst Hosp del Mar Invest Med, Hosp del Mar, Med Res Inst, Barcelona, Spain
[6] Pompeu Fabra Univ, Barcelona, Spain
[7] A Coruna Univ Hosp Complex, La Coruna, Spain
[8] San Carlos Univ Hospial, Madrid, Spain
[9] Ramon y Cajal Univ Hosp, Madrid, Spain
[10] Virgen de la Salud Hosp, Toledo, Spain
[11] Valencian Inst Oncol, Valencia, Spain
[12] Reina Sofia Hosp Complex, Biomed Res Inst, Cordoba, Spain
[13] Parc Tauli Hlth Corp, Barcelona, Spain
[14] Germans Trias & Pujol Univ Hosp, Barcelona, Spain
[15] Onkologikoa, Donostia San Sebastian, Spain
[16] Santa Creu & St Pau Hosp, Barcelona, Spain
[17] GEICAM Spanish Breast Canc Res Grp, Madrid, Spain
[18] Fdn Jimenez Diaz Univ Hosp, Madrid, Spain
来源
ONCOLOGIST | 2016年 / 21卷 / 02期
关键词
Ki67; Breast cancer; Neoadjuvant chemotherapy; Chemosensitivity; Predictive factor; PREOPERATIVE CHEMOTHERAPY; PROGNOSTIC-SIGNIFICANCE; INTERNATIONAL KI67; ESTROGEN-RECEPTOR; AMERICAN SOCIETY; KI-67; RECOMMENDATIONS; RECURRENCE; EXPRESSION; SURVIVAL;
D O I
10.1634/theoncologist.2015-0312
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background. In the neoadjuvant setting, changes in the proliferation marker Ki67 are associated with primary endocrine treatment efficacy, but its value as a predictor of response to chemotherapy is still controversial. Patients and Methods. We analyzed 262 patients with centralized basal Ki67 immunohistochemical evaluation derived from 4 GEICAM(Spanish Breast Cancer Group) clinical trials of neoadjuvant chemotherapy for breast cancer. The objective was to identify the optimal threshold for Ki67 using the receiver-operating characteristic curve method to maximize its predictive value for chemotherapy benefit. We also evaluated the predictive role of the defined Ki67 cutoffs for molecular subtypes defined by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). Results. A basal Ki67 cutpoint of 50% predicted pathological complete response (pCR). Patients with Ki67>50% achieved a pCR rate of 40% (36 of 91) versus a pCR rate of 19% in patients with Ki67 <= 50% (33 of 171) (p = .0004). Ki67 predictive value was especially relevant in ER-HER2- and ER-HER2+ patients (pCR rates of 42% and 64%, respectively, in patients with Ki67>50% versus 15% and 45%, respectively, in patients with Ki67 <= 50%; p = .0337 and .3238, respectively). Both multivariate analyses confirmed the independent predictive value of the Ki67 cutpoint of 50%. Conclusion. Basal Ki67 proliferation index >50% should be considered an independent predictive factor for pCR reached after neoadjuvant chemotherapy, suggesting that cell proliferation is a phenomenon closely related to chemosensitivity. These findings could help to identify a group of patients with a potentially favorable long-term prognosis.
引用
收藏
页码:150 / 155
页数:6
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