The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer
The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer
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DOI：
10.1007/s10549-008-0081-7
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发表时间：
2009-07-01
影响因子：
3.8
通讯作者：
Dowsett, Mitchell
中科院分区：
文献类型：
--
作者：
Jones, Robin L.;Salter, Janine;Dowsett, Mitchell
目的 比较新辅助化疗前后乳腺癌中通过 Ki67 表达评估的增殖的预后意义。方法对前瞻性维护的临床数据库进行回顾性检索，以确定在皇家马斯登医院接受新辅助化疗的患者。使用免疫组织化学方法评估治疗前芯针活检和治疗后手术切除标本中 Ki67 的表达。化疗前和化疗后考虑以下因素与无复发生存和总生存的关系：年龄、月经状况、T和N分期、治疗前可操作性、Ki67、ER、PgR、HER2、分级、组织学亚型、血管侵犯、临床反应、化疗方案、手术类型、辅助治疗、病理肿瘤大小和淋巴结受累。结果 在 103 名患者的匹配队列中，在无复发生存期的多变量分析中，治疗后 Ki67 是唯一显着的独立预后因素。在总生存期的多变量分析中，切除前和切除 Ki67 都是显着的独立预测因子，但后者显示出更强的预后影响。 Ki67 切除的最高和最低三分位数对于 5 年无复发（27% 与 77%）和总体（39% 和 93%）生存率具有不同的预后。在仅具有切除样本的 284 名患者队列中，治疗后 Ki67 是多变量分析中的一个重要的独立预后因素。结论 对于未达到病理完全缓解的患者，化疗后 Ki67 是结果的有力预测因子。
Purpose To compare the prognostic significance of proliferation, as assessed by Ki67 expression, in breast cancer before and after neoadjuvant chemotherapy. Methods A retrospective search of a prospectively maintained clinical database was performed to identify patients treated with neoadjuvant chemotherapy at the Royal Marsden Hospital. The expression of Ki67 was assessed using immunohistochemistry in pre-therapy core-needle biopsy and post-therapy surgical excision specimens. The following factors were considered pre- and post-chemotherapy for their relationship with relapse-free and overall survival: age, menstrual status, T and N stage, pre-therapy operability, Ki67, ER, PgR, HER2, grade, histological subtype, vascular invasion, clinical response, chemotherapy regimen, type of surgery performed, adjuvant therapy, pathological tumour size and nodal involvement. Results In a matched cohort of 103 patients, on multivariate analysis of relapse-free survival, post-therapy Ki67 was the only significant independent prognostic factor. On multivariate analysis for overall survival, both pre- and excision Ki67 were significant independent predictors but the latter showed a stronger prognostic impact. The highest and lowest tertiles of excision Ki67 had different prognosis for both 5-year relapse-free (27% vs. 77%) and overall (39% and 93%) survival. In a cohort of 284 patients with only excision samples, post-therapy Ki67 was a significant independent prognostic factor on multivariate analysis. Conclusion Post-chemotherapy Ki67 is a strong predictor of outcome for patients not achieving a pathological complete response.