Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
Breast Cancer Res Treat. 2017 Jul;164(2):395-400. doi: 10.1007/s10549-017-4266-9. Epub 2017 Apr 26.
To determine whether IHC4 score assessed on pre-treatment core biopsies (i) predicts response to neo-adjuvant chemotherapy in ER-positive (ER+) breast cancer; (ii) provides more predictive information than Ki67 alone.
113 patients with ER+ primary breast cancer treated with neo-adjuvant chemotherapy at the Royal Marsden Hospital between 2002 and 2010 were included in the study. Pathologic assessment of the excision specimen was made for residual disease. IHC4 was determined on pre-treatment core biopsies, blinded to clinical outcome, by immunohistochemistry using quantitative scoring of ER (H-score), PgR (%) and Ki67 (%). Determination of HER2 status was made by immunohistochemistry and fluorescent in situ hybridization for 2+ cases. IHC4 and Ki67 scores were tested for their association with pathological complete response (pCR) rate and residual cancer burden (RCB) score.
18 (16%) of the 113 patients and 8 (9%) of the 88 HER2-ve cases achieved pCR. Ki67 and IHC4 score were both positively associated with achievement of pCR (P < 10 and P < 10, respectively) and RCB0+1 (P < 10 and P < 10, respectively) following neo-adjuvant chemotherapy in all patients. Rates of pCR+RCB1 were 45 and 66% in the highest quartiles of Ki67 and IHC4 scores, respectively. In ER+HER2-ve cases, pCR+RCB1 rates were 35% and in the highest quartile of both Ki67 and IHC4. There were no pCRs in the lower half of IHC4 or Ki67 scores.
IHC4 was strongly predictive of pCR or near pCR in ER+ breast cancers following neo-adjuvant chemotherapy. Ki67 was an important component of this predictive ability, but was not as predictive as IHC4.
确定在新辅助化疗前的核心活检中评估 IHC4 评分（i）是否可以预测 ER 阳性（ER+）乳腺癌对新辅助化疗的反应；（ii）是否比 Ki67 单独提供更多的预测信息。
纳入 2002 年至 2010 年在皇家马斯登医院接受新辅助化疗的 113 例 ER+原发性乳腺癌患者。对切除标本进行残留疾病的病理评估。通过免疫组化使用 ER（H 评分）、PgR（%）和 Ki67（%）的定量评分，对新辅助化疗前的核心活检进行 IHC4 测定，该测定对临床结果是盲态的。HER2 状态通过免疫组化和 2+病例的荧光原位杂交来确定。测试 IHC4 和 Ki67 评分与病理完全缓解（pCR）率和残留癌负荷（RCB）评分的相关性。
113 例患者中有 18 例（16%）和 88 例 HER2-ve 病例中有 8 例（9%）达到 pCR。Ki67 和 IHC4 评分均与所有患者接受新辅助化疗后获得 pCR（P<10 和 P<10）和 RCB0+1（P<10 和 P<10）呈正相关。Ki67 和 IHC4 评分最高四分位数的 pCR+RCB1 率分别为 45%和 66%。在 ER+HER2-ve 病例中，pCR+RCB1 率为 35%，Ki67 和 IHC4 的最高四分位数均为 35%。在 IHC4 或 Ki67 评分的下半部分没有 pCR。
在 ER+乳腺癌患者接受新辅助化疗后，IHC4 强烈预测 pCR 或接近 pCR。Ki67 是这种预测能力的重要组成部分，但不如 IHC4 具有预测性。
