Department of Surgery, Breast Cancer Center, Gachon University Gil Hospital, Incheon, Korea.
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
J Breast Cancer. 2015 Mar;18(1):16-21. doi: 10.4048/jbc.2015.18.1.16. Epub 2015 Mar 27.
Patients with triple-negative breast cancer (TNBC) with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) have superior survival outcomes compared to those with residual disease after NAC. This study investigated the value of three biomarkers, p53, Ki-67, and Bcl-2 for predicting pCR in NAC-treated patients with TNBC.
Between 2003 and 2012, 198 patients with pathologically confirmed primary TNBC were treated with two different taxane-based chemotherapeutic regimens prior to surgery. Before NAC, expression of p53 (cutoff 25%), Ki-67 (cutoff 10%), and Bcl-2 (cutoff 10%) was assessed immunohistochemically in core biopsy specimens. The incidence of pCR was correlated with the expression of these biomarkers.
Overall, pCR occurred in 37 of the 198 patients (18.7%). A significant association was observed between the pCR rate and overexpression of the p53 and Ki-67 biomarkers. Multivariate analysis showed that only p53 expression was independently associated with pCR to NAC (odds ratio, 3.961; p=0.003). The sensitivity, specificity, positive predictive value, and negative predictive value of p53 expression for predicting pCR were 77.8%, 50.3%, 26.2%, and 90.9%, respectively. The pCR rate was the lowest (5.2%) in patients with low expression of both p53 and Ki-67, and it was the highest (25.8%) when both biomarkers showed high expression.
Expression of p53 was significantly associated with pCR after NAC in patients with TNBC, suggesting that this biomarker might be particularly valuable in identifying TNBC patients prone to have residual disease after NAC.
与新辅助化疗（NAC）后仍有残留疾病的患者相比，三阴性乳腺癌（TNBC）患者病理完全缓解（pCR）的生存结局更好。本研究调查了三种生物标志物（p53、Ki-67 和 Bcl-2）在预测接受 NAC 治疗的 TNBC 患者 pCR 中的价值。
2003 年至 2012 年间，198 例经病理证实的原发性 TNBC 患者在手术前接受了两种不同的紫杉烷类化疗方案治疗。在 NAC 前，通过核心活检标本免疫组织化学评估 p53（截断值 25%）、Ki-67（截断值 10%）和 Bcl-2（截断值 10%）的表达。将 pCR 的发生率与这些生物标志物的表达相关联。
总体而言，198 例患者中有 37 例（18.7%）发生 pCR。pCR 率与 p53 和 Ki-67 生物标志物的过度表达之间存在显著相关性。多变量分析显示，只有 p53 表达与 NAC 后 pCR 独立相关（优势比，3.961；p=0.003）。p53 表达预测 pCR 的灵敏度、特异性、阳性预测值和阴性预测值分别为 77.8%、50.3%、26.2%和 90.9%。p53 和 Ki-67 表达均低的患者 pCR 率最低（5.2%），而两个生物标志物均高表达的患者 pCR 率最高（25.8%）。
p53 表达与 TNBC 患者 NAC 后 pCR 显著相关，提示该生物标志物可能特别有助于识别 NAC 后仍有残留疾病风险的 TNBC 患者。
