S.C. Oncologia Medica C, Istituto Nazionale per Ricerca sul Cancro, ASL3 Genovese, Genova, Italy.
Oncology. 2010;79(3-4):255-61. doi: 10.1159/000322189. Epub 2011 Mar 4.
Breast cancers expressing high levels of Ki-67, a nuclear marker of cell proliferation, are associated with worse outcome. Recent data from neoadjuvant studies indicate that a single measurement of the nuclear proliferation marker Ki-67 in breast carcinoma during neoadjuvant therapy is strongly predictive of long-term outcome. Secondly, recent literature data indicate that prognostic evaluation with Ki-67 may be better after pre-surgical therapy. A retrospective study from a prospectively maintained clinical database to compare the predictive and prognostic significance of biological markers, assessed before and after neoadjuvant chemotherapy, in locally advanced breast cancer, was performed.
The following parameters were considered before and after chemotherapy for their relationship with treatment response and disease-free survival in 64 patients with locally advanced breast cancer: clinical stage, clinical and pathological lymph node involvement, Ki-67, estrogen receptor (ER), progesterone receptor (Pgr), Her2, tumor grade, clinical response, type of surgery performed, and number of chemotherapy cycles administered. The expression of Ki-67 was assessed using immunohistochemistry in pre-therapy tru-cut and post-therapy surgical excision specimens after neoadjuvant chemotherapy; only patients with breast tumors expressing high baseline Ki-67 (≥ 15%) were included in the analysis. In addition, the correlation between pre-chemotherapy biological markers and clinical and pathological response was reported.
Post-chemotherapy Ki-67 proliferation index decrease, pre-chemotherapy ER expression and post-chemotherapy ER expression were the only significant prognostic factors adversely influencing disease-free survival in univariate analysis. Her2 overexpression was the only factor to impact on the clinical response.
Post-treatment Ki-67 and ER status were predictors of outcome for patients with locally advanced breast cancer and a high pre-chemotherapy proliferation index.
表达高水平核增殖标志物 Ki-67 的乳腺癌与较差的预后相关。新辅助研究的近期数据表明，在新辅助治疗期间单次测量乳腺癌中核增殖标志物 Ki-67 对长期预后具有很强的预测性。其次，最近的文献数据表明，在术前治疗后，Ki-67 的预后评估可能更好。本研究从前瞻性维护的临床数据库中回顾性地比较了局部晚期乳腺癌患者新辅助化疗前后生物标志物的预测和预后意义，这些标志物在化疗前后进行了评估。
在 64 例局部晚期乳腺癌患者中，我们考虑了以下参数，以评估其与治疗反应和无病生存的关系：临床分期、临床和病理淋巴结受累、Ki-67、雌激素受体 (ER)、孕激素受体 (Pgr)、Her2、肿瘤分级、临床反应、手术类型和化疗周期数。在新辅助化疗前后，使用免疫组织化学法评估 Ki-67 在治疗前 tru-cut 和治疗后手术切除标本中的表达；仅纳入 Ki-67 基线高表达（≥ 15%）的乳腺癌患者进行分析。此外，还报告了化疗前生物标志物与临床和病理反应之间的相关性。
化疗后 Ki-67 增殖指数下降、化疗前 ER 表达和化疗后 ER 表达是单因素分析中唯一显著影响无病生存的预后因素。Her2 过表达是唯一影响临床反应的因素。
治疗后 Ki-67 和 ER 状态是局部晚期乳腺癌和高化疗前增殖指数患者的预后预测因素。
