Changes in PgR and Ki-67 in residual tumour and outcome of breast cancer patients treated with neoadjuvant chemotherapy
Changes in PgR and Ki-67 in residual tumour and outcome of breast cancer patients treated with neoadjuvant chemotherapy
复制标题
DOI：
10.1093/annonc/mdu528
复制
发表时间：
2015-02-01
影响因子：
50.5
通讯作者：
Colleoni, M.
中科院分区：
文献类型：
--
作者：
Montagna, E.;Bagnardi, V.;Colleoni, M.
背景：关于乳腺癌患者新辅助治疗后残留肿瘤生物学特征变化的预后价值，可获得的数据有限。患者和方法：我们通过机构临床数据库收集了1999年至2011年期间在意大利米兰的欧洲肿瘤学研究所(IEO)接受新辅助化疗的所有连续乳腺癌患者的信息。我们选择了在最后一次手术中没有达到病理完全反应的患者。所有患者在诊断性核心活检和最终手术时均进行病理评估，包括ER、PGR、HER2蛋白和Ki-67的表达。在诊断性活检中ER阳性的患者中，有5%的患者在最终手术时ER阴性的残留肿瘤。对于PGR表达，67%的肿瘤在诊断活检时PGR和GT；20%在最终手术时PGR和GT；20%。在40%的患者中，Ki-67的表达从20%变为20%。在多因素分析中，PgR免疫反应阳性细胞的减少与无病生存率的改善相关[危险比(HR)0.73；95%可信区间(CI)0.54-1.00，P 0.046]。此外，在最终手术时Ki-67表达降低到20%的细胞与较好的预后相关(HR0.52；95%CI0.40-0.68P<；0.0001)和总生存期(HR0.45；95%CI0.32-0.64，P<；0.0001)。结论：术前化疗后PGR和Ki-67表达的降低对有残留病变的乳腺癌患者有预后作用。
Background: Limited data are available on the prognostic value of changes in the biological features of residual tumours following neoadjuvant therapies in breast cancer patients.Patients and methods: We collected information through the institutional clinical database on all consecutive breast cancer patients treated with neoadjuvant chemotherapy at the European Institute of Oncology (IEO), Milan, Italy, between 1999 and 2011. We selected patients who did not achieve pathological complete response at final surgery. All patients had a pathological evaluation, including ER, PgR, HER2 protein and Ki-67 expression carried out at the IEO both at diagnostic core biopsy and at final surgery.Results: We identified a total of 904 patients. The 5% of patients who were ER positive at diagnostic biopsy had ER-negative residual tumour at final surgery. For PgR expression, 67% of the patients, whose tumours had a PgR > 20% at diagnostic biopsy had a PgR < 20% at final surgery. The Ki-67 expression changed from > 20% to < 20% in 40% of the patients. At the multivariate analysis, the decrease of PgR-immunoreactive cells correlated with improved outcome in terms of disease-free survival (DFS) [hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.54-1.00, P 0.046]. In addition, the decrease of Ki-67 expression to < 20% of the cells at final surgery was found to be associated with better outcome both in terms of DFS (HR 0.52; 95% CI 0.40-0.68 P < 0.0001) and overall survival (HR 0.45; 95% CI 0.32-0.64, P < 0.0001).Conclusion: The decrease of PgR and Ki-67 expression after preoperative chemotherapy has a prognostic role in breast cancer patients with residual disease.