Ki67 expression in the primary tumor predicts for clinical benefit and time to progression on first-line endocrine therapy in estrogen receptor-positive metastatic breast cancer
Ki67 expression in the primary tumor predicts for clinical benefit and time to progression on first-line endocrine therapy in estrogen receptor-positive metastatic breast cancer
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DOI：
10.1007/s10549-012-2194-2
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发表时间：
2012-09-01
影响因子：
3.8
通讯作者：
Pusztai, L.
中科院分区：
文献类型：
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作者：
Delpech, Y.;Wu, Y.;Pusztai, L.
我们研究了雌激素受体阳性（ER+）原发性乳腺癌的基线Ki 67表达是否与一线内分泌治疗的临床获益和进展时间以及转移性疾病的生存率相关。Ki 67值和结果信息从前瞻性维护的临床数据库中检索，并根据医疗记录进行验证;纳入了241例转移性乳腺癌患者，他们患有ER+原发性癌症，Ki 67表达水平已知，并接受了转移性疾病的一线内分泌治疗。患者被分配到低（<10%）、中等（10- 25%）或高（> 25%）Ki 67表达组。绘制Kaplan-Meier生存曲线，并进行多变量分析，以评估临床和免疫组化变量与结局之间的相关性。低（n = 32）、中等（n = 103）和高（n = 106）Ki 67表达组的临床获益率分别为81%、65%和55%（P = 0.001）。一线内分泌治疗的中位至进展时间分别为20.3（95%CI，17.5-38.5）、10.8（95%CI，8.9-18.8）和8（95%CI，6.1-11.1）个月（P = 0.0002）。低/中等Ki 67组诊断转移性疾病后的中位生存时间也长于高Ki 67组，52个月对30个月（P < 0.0001）。在多因素分析中，原发肿瘤中Ki 67的高表达仍然是转移性疾病的独立不良预后因素（P = 0.001）。原发性肿瘤中Ki 67的低表达与一线内分泌治疗的较高临床获益和较长的进展时间以及转移性复发后的较长生存期相关。
We examined whether baseline Ki67 expression in estrogen receptor-positive (ER+) primary breast cancer correlates with clinical benefit and time to progression on first-line endocrine therapy and survival in metastatic disease. Ki67 values and outcome information were retrieved from a prospectively maintained clinical database and validated against the medical records; 241 patients with metastatic breast cancer were included-who had ER+ primary cancer with known Ki67 expression level-and received first-line endocrine therapy for metastatic disease. Patients were assigned to low (< 10 %), intermediate (10-25 %), or high (> 25 %) Ki67 expression groups. Kaplan-Meier survival curves were plotted and multivariate analysis was performed to assess association between clinical and immunohistochemical variables and outcome. The clinical benefit rates were 81, 65, and 55 % in the low (n = 32), intermediate (n = 103), and high (n = 106) Ki67 expression groups (P = 0.001). The median times to progression on first-line endocrine therapy were 20.3 (95 % CI, 17.5-38.5), 10.8 (95 % CI, 8.9-18.8), and 8 (95 % CI, 6.1-11.1) months, respectively (P = 0.0002). The median survival times after diagnosis of metastatic disease were also longer for the low/intermediate compared to the high Ki67 group, 52 versus 30 months (P < 0.0001). In multivariate analysis, high Ki67 expression in the primary tumor remained an independent adverse prognostic factor in metastatic disease (P = 0.001). Low Ki67 expression in the primary tumor is associated with higher clinical benefit and longer time to progression on first-line endocrine therapy and longer survival after metastatic recurrence.