A prognostic model based on nodal status and Ki-67 predicts the risk of recurrence and death in breast cancer patients with residual disease after preoperative chemotherapy
A prognostic model based on nodal status and Ki-67 predicts the risk of recurrence and death in breast cancer patients with residual disease after preoperative chemotherapy
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DOI：
10.1093/annonc/mdn761
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发表时间：
2009-07-01
影响因子：
50.5
通讯作者：
Conte, P.
中科院分区：
文献类型：
--
作者：
Guarneri, V.;Piacentini, F.;Conte, P.
方法：纳入221例II - III期乳腺癌患者。在新辅助化疗（PCT）前基线水平以及手术标本中对以下参数进行评估：雌激素受体（ER）、孕激素受体（PgR）、人表皮生长因子受体2（HER2）、Ki - 67、p53、人表皮生长因子受体（EGFR）、血管内皮生长因子受体2（VEGFR2）以及细胞凋亡情况。
结果：8.8%的患者观察到病理完全缓解。PCT使ER、PgR、Ki - 67的表达以及细胞凋亡显著减少。根据多变量模型，Ki - 67≥15%以及术前化疗（PCT）后的淋巴结阳性是无病生存期较差的显著预测因素[风险比（HR）分别为3.79，P < 0.0001和HR为2.31，P = 0.037]。PCT后Ki - 67≥15%也是总生存期的显著预测因素（HR为3.75，P = 0.013）。基于这两个参数，患者被分为三组：（i）低风险组（淋巴结阴性且Ki - 67 < 15%），（ii）中风险组（淋巴结阳性或Ki - 67≥15%），（iii）高风险组（淋巴结阳性且Ki - 67≥15%）。与低风险组相比，中风险组和高风险组复发的风险比分别为3.1和9.3（P = 0.0001）；中风险组和高风险组死亡的风险比分别为2.4和6.5（P = 0.042）。
结论：Ki - 67和淋巴结状态已被用于构建一个简单且易于重现的预后模型，能够在PCT后有残留疾病的异质性女性群体中区分出预后较差的患者。
Methods: Two hundred and twenty-one stage II-III breast cancer patients were included. The following parameters were evaluated at baseline and on surgical specimens after PCT: estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), Ki-67, p53, human epidermal growth factor receptor (EGFR), vascular endothelial growth factor receptor 2 (VEGFR2), and apoptosis.Results: A pathological complete response was observed in 8.8% of the patients. PCT induced a significant reduction in the expression of ER, PgR, Ki-67, and apoptosis. As by multivariable model, Ki-67 >= 15% and nodal positivity after preoperative chemotherapy (PCT) were significant predictors of worse disease-free survival [hazard ratio (HR) 3.79, P < 0.0001 and HR 2.31, P = 0.037, respectively]. Ki-67 >= 15% after PCT was also a significant predictor of overall survival (HR 3.75, P = 0.013). On the basis of these two parameters, patients were classified into three groups: (i) low risk (negative nodes and Ki-67 < 15%), (ii) intermediate risk (nodal positivity or Ki-67 >= 15%), and (iii) high risk (nodal positivity and Ki-67 >= 15%). As compared with the low-risk group, the HRs for recurrence were 3.1 and 9.3 for the intermediate- and high-risk group, respectively (P = 0.0001); the HRs for death were 2.4 and 6.5 for the intermediate- and high-risk group, respectively (P = 0.042).Conclusions: Ki-67 and nodal status have been used to generate a simple and easily reproducible prognostic model, able to discriminate patients with worse prognosis among the heterogeneous group of women with residual disease after PCT.