Maeda Yuka, Sato Ayana, Matsumoto Akiko, Ikeda Tatsuhiko, Jinno Hiromitsu
Department of Surgery, School of Medicine, Teikyo University, Tokyo, Japan.
Breast J. 2025 May 22;2025:9976413. doi: 10.1155/tbj/9976413. eCollection 2025.
Although presurgical endocrine therapy has been used to enhance the rate of breast cancer conservation, its prognostic relevance is unknown. The search for a valid prognostic factor equivalent to pathological complete response in presurgical chemotherapy remains a challenge in presurgical endocrine therapy. This study investigated the efficacy of presurgical short-term endocrine therapy (preSTE) and assessed prognostic factors, including the preoperative endocrine prognostic index (PEPI) score. From October 2012 to November 2021, 269 postmenopausal women diagnosed with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative breast cancer underwent endocrine therapy with a nonsteroidal aromatase inhibitor during the presurgical waiting period. The primary endpoint was to assess the changes in tumor size using ultrasonography, and Ki67 expression levels before and after preSTE. The secondary endpoint was the prognosis of patients categorized using the PEPI score. The median age of patients was 68 years (range, 41-89 years). The median tumor size was 1.65 cm (range, 0.4-7.5 cm). The average pretreatment Ki67 expression level was 10% (range, 0%-90%). The median duration of endocrine therapy was 39 days (range, 2-88 days). Tumor diameter and Ki67 expression levels were significantly decreased to 1.43 cm (range, 0.45-5.83 cm) and 3.0% (range, 0%-85%) after preSTE, respectively. After the median observation period of 928 days, patients with PEPI scores ≥ 4 showed worse disease-free survival compared with those with lower PEPI scores. In terms of mortality, patients with PEPI score ≥ 4 had worse overall survival than did patients with lower PEPI scores. Endocrine therapy during the waiting period for surgery might be effective in reducing tumor size, and the Ki67 expression level and PEPI score might be useful in predicting the prognosis of patients with postmenopausal HR+ breast cancer.
尽管术前内分泌治疗已被用于提高保乳率，但其预后相关性尚不清楚。在术前内分泌治疗中，寻找一个与术前化疗中病理完全缓解等效的有效预后因素仍然是一项挑战。本研究调查了术前短期内分泌治疗（preSTE）的疗效，并评估了包括术前内分泌预后指数（PEPI）评分在内的预后因素。2012年10月至2021年11月，269名诊断为激素受体阳性（HR+）、人表皮生长因子受体2阴性乳腺癌的绝经后女性在术前等待期接受了非甾体芳香化酶抑制剂内分泌治疗。主要终点是使用超声评估肿瘤大小的变化，以及preSTE前后的Ki67表达水平。次要终点是使用PEPI评分对患者进行分类的预后。患者的中位年龄为68岁（范围41-89岁）。中位肿瘤大小为1.65厘米（范围0.4-7.5厘米）。预处理前Ki67平均表达水平为10%（范围0%-90%）。内分泌治疗的中位持续时间为39天（范围2-88天）。preSTE后，肿瘤直径和Ki67表达水平分别显著降至1.43厘米（范围0.45-5.83厘米）和3.0%（范围0%-85%）。在928天的中位观察期后，PEPI评分≥4的患者与PEPI评分较低的患者相比，无病生存期更差。在死亡率方面，PEPI评分≥4的患者总生存期比PEPI评分较低的患者更差。手术等待期的内分泌治疗可能对减小肿瘤大小有效，Ki67表达水平和PEPI评分可能有助于预测绝经后HR+乳腺癌患者的预后。
