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Qian X, Xiu M, Li Q, Wang J, Fan Y, Luo Y, Cai R, Li Q, Chen S, Yuan P, Ma F, Xu B, Zhang P. Clinical N3 is an independent risk factor of recurrence for breast cancer patients achieving pathological complete response and near-pathological complete response after neoadjuvant chemotherapy. Front Oncol 2022; 12:1019925. [PMID: 36276123 PMCID: PMC9582118 DOI: 10.3389/fonc.2022.1019925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although achieving pathological complete response (pCR) and near-pathological complete response (near-pCR) after neoadjuvant chemotherapy (NAC) in breast cancer predicts a better outcome, some patients still experience recurrence. The aim of our study was to investigate the predictive factors of recurrence in the pCR and near-pCR population. Methods We reviewed 1,209 breast cancer patients treated with NAC between January 2010 and April 2021 in the Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS). A total of 292 patients achieving pCR and near-pCR were included in our analysis. pCR was defined as ypT0N0/ypTisN0. Near-pCR was defined as ypT1mi/1a/1bN0 or ypT0/isN1mi. Clinical features and follow-up information were collected. Survival and predictive factors of recurrence were analyzed. Results Of the 292 patients, 173 were pCR and 119 were near-pCR. The median age was 46 years (range, 23–75 years). The predominant tumor subtypes were human epidermal growth factor receptor type 2 (HER2)-positive breast cancer (49.0%) and triple-negative breast cancer (TNBC) (30.8%). The median duration of follow-up was 53 months (range, 9–138 months). A total of 25 (8.6%) patients developed recurrence, with 9 (5.2%) in the pCR group and 16 (13.4%) in the near-pCR group. The vast majority of recurrence occurred within 36 months from onset of NAC. The 5-year recurrence-free survival (RFS) rate of patients achieving pCR was significantly higher than that of patients achieving near-pCR (94.6% vs. 85.6%, p = 0.008). However, the 5-year overall survival (OS) rate between the two cohorts had no statistical difference (94.3% vs. 89.6%, p = 0.304). Clinical N3 (cN3) before NAC was an independent risk factor of recurrence in patients who achieved pCR (p = 0.003) and near-pCR (p = 0.036). Tumor size before NAC, subtypes of breast cancer, and chemotherapy regimens showed no significant association with RFS both for patients who achieved pCR and for those who achieved near-pCR (p > 0.05). Conclusions cN3 before NAC was an independent risk factor of recurrence in patients who achieved pCR and near-pCR. It is worthwhile to closely monitor patients with cN3, especially in the first 3 years.
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Affiliation(s)
- Xiaoyan Qian
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Oncology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Xiu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruigang Cai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Yuan
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Pin Zhang,
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Abd El Khalek S, Mohammed M, Hafez F. Predictive value of Ki67 for complete pathological response to neoadjuvant chemotherapy in patients with breast cancer. EGYPTIAN JOURNAL OF PATHOLOGY 2021; 41:194. [DOI: 10.4103/egjp.egjp_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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3
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Omranipour R, Jalili R, Yazdankhahkenary A, Assarian A, Mirzania M, Eslami B. Evaluation of Pathologic Complete Response (pCR) to Neoadjuvant Chemotherapy in Iranian Breast Cancer Patients with Estrogen Receptor Positive and HER2 Negative and impact of predicting variables on pCR. Eur J Breast Health 2020; 16:213-218. [PMID: 32656523 DOI: 10.5152/ejbh.2020.5487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/17/2020] [Indexed: 12/31/2022]
Abstract
Objective The pathologic complete response (pCR) in the breast and axillary lymph node after neoadjuvant chemotherapy (NAC) would improve outcomes and it is used as a surrogate marker for survival. Our objective was to evaluate the breast and nodal pCR in breast cancer patients with estrogen receptor-positive (ER) and HER2 negative subtypes. Meanwhile, we sought to examine the impact of predicting factors on the rate of pCR. Materials and Methods In this multicenter retrospective study, medical records data of 314 women with ER+/HER2- breast cancer subtype who received neoadjuvant chemotherapy was extracted from oncology centers' data between 2011 and 2018. Breast and axillary lymph node pCR were assessed. Meanwhile, receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value for proliferative index (Ki-67%) expression. Results Breast pCR was seen in 25.2% (n=79) of the 314 cancer patients and partial response was seen in 47.8% (n=150), too. Nodal pCR was reported in 30.9% (n=97) of the 249 node-positive patients. The overall pCR (both breast & node) was observed in 14.6 % (n=46) of the 272 patients in which the data of breast and nodal were available. We identified 22.5% as the best cut-off value for ki-67 expression in predicting complete response to NAC. Conclusion The pCR rate after NAC in ER+/HER2- subtypes of breast cancer is low. Therefore, the optimal therapy for these patients should be further investigated.
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Affiliation(s)
- Ramesh Omranipour
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roghiyeh Jalili
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Adel Yazdankhahkenary
- Trauma and Surgery Research Center, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolali Assarian
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad Mirzania
- Department of Hematology and Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Eslami
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran
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Jain P, Doval DC, Batra U, Goyal P, Bothra SJ, Agarwal C, Choudhary DK, Yadav A, Koyalla VPB, Sharma M, Dash P, Talwar V. Ki-67 labeling index as a predictor of response to neoadjuvant chemotherapy in breast cancer. Jpn J Clin Oncol 2019; 49:329-338. [DOI: 10.1093/jjco/hyz012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/28/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Parveen Jain
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Dinesh Chandra Doval
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Ullas Batra
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Pankaj Goyal
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Sneha Jatan Bothra
- DNB Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Chaturbhuj Agarwal
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | | | - Abhishek Yadav
- Medical Oncology, Fortis Shalimar Bagh, New Delhi, India
| | | | - Mansi Sharma
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Prashanta Dash
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Vineet Talwar
- Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
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Chen J, Hao Y, Chen J, Huang L, Ao W, Yang J, Li L, Heng J, Chen Z, Liang W, Hao X, Gao W. Colony stimulating factor-1 receptor promotes proliferation, migration and invasion in the human nasopharyngeal carcinoma 6-10B cell line via the phosphoinositide 3-kinase/Akt pathway. Oncol Lett 2018; 16:1205-1211. [PMID: 30061942 DOI: 10.3892/ol.2018.8750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/21/2018] [Indexed: 12/18/2022] Open
Abstract
The present study aimed to investigate the effects of colony-stimulating factor-1 receptor (CSF-1R) on proliferation, migration and invasion in the human nasopharyngeal carcinoma (NPC) 6-10B cell line, and to investigate the possible underlying mechanisms. Using a lentiviral transfection method, a virus carrying the CSF-1R gene was transfected into 6-10B cells. The expression of CSF-1R was then detected by reverse transcription-quantitative polymerase chain reaction and western blot analysis, and was revealed to be markedly enhanced in 6-10B cells. Subsequently, an MTT assay was performed to assess cell proliferative ability, and flow cytometric analysis was utilized to measure the apoptotic rate of the cells. Wound healing and Transwell assays were also performed to observe cell migration and invasion capabilities. Additionally, western blot analysis was used to detect the protein expression of the proliferation and apoptosis signaling factors cyclin D1, B-cell lymphoma 2, Bcl-2-associated X protein, and phosphorylated and total extracellular protein kinase B (Akt/PKB) in 6-10B cells. The results showed that CSF-1R overexpression promoted the proliferation, migration and invasion of the 6-10B cells. The corresponding mechanism may be associated with activation of the phosphoinositide 3-kinase/Akt pathway, which promotes cell survival and proliferation. These results indicated a potential molecular target for the treatment of NPC.
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Affiliation(s)
- Jiayu Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430000, P.R. China.,Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Yanrong Hao
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Jiaxin Chen
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Li Huang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430000, P.R. China
| | - Wen Ao
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Jiao Yang
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Lei Li
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Junping Heng
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Zhaohon Chen
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Wuqing Liang
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Xin Hao
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Weiwei Gao
- Cancer Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
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Tao M, Chen S, Zhang X, Zhou Q. Ki-67 labeling index is a predictive marker for a pathological complete response to neoadjuvant chemotherapy in breast cancer: A meta-analysis. Medicine (Baltimore) 2017; 96:e9384. [PMID: 29390540 PMCID: PMC5758242 DOI: 10.1097/md.0000000000009384] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) is a strong indicator of the benefit of therapy and presents an early surrogate for a favorable long-term outcome. It remains unclear whether Ki-67, a marker for tumor proliferation, can function as a predictor of the response to NCT in breast cancer. The objective of this meta-analysis was to compare the pCR rate and clinical outcomes in breast cancer patients with different Ki-67 labeling indexes (Ki-67 LI) who received NCT. METHODS Clinical studies were retrieved from the electronic databases of PubMed, Embase, Clinical Trials, Wanfang, and the Chinese National Knowledge Infrastructure, from their inception to July 31, 2017. Meta-analysis was performed on pool eligible studies to determine whether Ki-67 LI was associated with the pCR rate and clinical outcomes of breast cancer patients who were treated with NCT. Pooled analyses were performed using fixed effects models. Two reviewers screened all titles and abstracts and independently assessed all articles. RESULTS A total of 36 studies involving 6793 patients were included in the meta-analysis. Pooled analysis results revealed that patients with high Ki-67 LI exhibited significantly higher pCR rates (odds ratio [OR] = 3.94, 95% confidence interval [CI]: 3.33-4.67, P <.001) but poorer relapse-free survival (OR = 1.99, 95% CI: 1.39-2.85, P <.001) than those with low Ki-67 LI, but there was no significant difference in objective tumor response rate. CONCLUSION The meta-analysis reported here demonstrates that pretherapeutic Ki-67 LI is associated with pCR in breast cancer patients undergoing NCT. More phase III randomized clinical trials will be required to confirm our findings.
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Affiliation(s)
| | | | - Xianquan Zhang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zhou
- Fuling Center Hospital of Chongqing City
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7
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Villegas SL, Darb-Esfahani S, von Minckwitz G, Huober J, Weber K, Marmé F, Furlanetto J, Schem C, Pfitzner BM, Lederer B, Engels K, Kümmel S, Müller V, Mehta K, Denkert C, Loibl S. Expression of Cyclin D1 protein in residual tumor after neoadjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 2017; 168:179-187. [PMID: 29177689 DOI: 10.1007/s10549-017-4581-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Hormone receptor (HR)-positive breast cancer (BC) shows a poor response to neoadjuvant chemotherapy (NACT). New treatment targets like the Cyclin D1-CDK4/CDK6 complex are promising adjuvant/post-neoadjuvant therapeutic strategies. Evaluating Cyclin D1 overexpression in residual tumor could recognize those patients that benefit most from such post-neoadjuvant treatment. In this study, we determined Cyclin D1 expression in residual BC after NACT. Secondary aims were to correlate Cyclin D1 expression levels with clinicopathological parameters and to assess its prognostic value after NACT. METHODS We retrospectively assessed the nuclear expression of Cyclin D1 on tissue microarrays with residual tumor from 284 patients treated in the neoadjuvant GeparTrio (n = 186) and GeparQuattro (n = 98) trials. Evaluation was performed with a standardized immunoreactive score (IRS) after selecting a cut-off value. RESULTS A high expression level (IRS ≥ 6) of Cyclin D1 was found in 37.3% of the assessed specimens. An increased Cyclin D1 expression was observed in HR-positive tumors, compared to HR-negative tumors (p = 0.02). Low Cyclin D1 levels correlated with clinical tumor stage 1-3 (p = 0.03). Among patients with HR-positive/Her2-negative tumors and high Cyclin D1 expression, a better disease-free survival (DFS) was graphically suggested, but not significant (p = 0.21). CONCLUSION Our study demonstrates a measurable nuclear expression of Cyclin D1 in post-neoadjuvant residual tumor tissue of HR-positive BC. Cyclin D1 expression was not prognostic for DFS after NACT. Our results and defined cut-off suggest that the marker can be used to stratify tumors according to protein expression levels. Based on this, a prospective evaluation is currently performed in the ongoing Penelope-B trial.
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Affiliation(s)
- S L Villegas
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Institute of Pathology Spandau, Evangelisches Waldkrankenhaus, Stadtrandstr. 555, 13589, Berlin, Germany
| | - G von Minckwitz
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - J Huober
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - K Weber
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - F Marmé
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - J Furlanetto
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - C Schem
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Hostein, Kiel, Germany
| | - B M Pfitzner
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - B Lederer
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss, Germany
| | - S Kümmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - K Mehta
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,German Cancer Consortium (DKTK), Partner Site Charité, Berlin, Germany.
| | - S Loibl
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
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8
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Chiari D, Orsenigo E, Guarneri G, Baiocchi GL, Mazza E, Albarello L, Bissolati M, Molfino S, Staudacher C. Effect of neoadjuvant chemotherapy on HER-2 expression in surgically treated gastric and oesophagogastric junction carcinoma: a multicentre Italian study. Updates Surg 2017; 69:35-43. [PMID: 28276033 DOI: 10.1007/s13304-017-0423-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/21/2017] [Indexed: 12/22/2022]
Abstract
Predictors of response to neoadjuvant chemotherapy are not available for gastric and oesophago-gastric junction carcinoma. HER-2 over-expression in breast cancer correlates with poor prognosis and high incidence of recurrence. First aim of this study was to evaluate if the HER-2 expression/amplification is predictive of response to neoadjuvant chemotherapy in terms of pathologic regression. Secondary aim was to evaluate if HER-2 expression varies after neoadjuvant treatment. Thirty-five patients with locally advanced gastric or oesophago-gastric junction carcinoma underwent preoperative chemotherapy and surgical resection at San Raffaele Scientific Institute and Spedali Civili of Brescia. HER-2 expression/amplification was evaluated on every biopsy at diagnosis time and on every surgical sample after neoadjuvant chemotherapy. Pathologic response to chemotherapy was evaluated according to TNM classification (ypT status and ypN status) and Mandard's tumour regression grade classification. In our series 10 patients (28.6%) showed a reduction in HER-2 overexpression and in 6 of them (17.1%) HER-2 expression completely disappeared. Only three of the six patients with HER-2 disappearance had a complete pathological response to neoadjuvant chemotherapy. There was a strong correlation between HER-2 negativity on biopsy and absence of lymph node metastasis in surgical samples after neoadjuvant chemotherapy, irrespective of nodal status before chemotherapy. A direct correlation between HER-2 reduction after neoadjuvant chemotherapy and pathologic regression (primary tumour and lymph nodes) in surgical samples was found. HER-2 negativity may represent a predictor of pathologic response to neoadjuvant chemotherapy for gastric and oesophago-gastric junction adenocarcinoma. Neoadjuvant treatment can reduce HER-2 overexpression.
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Affiliation(s)
- Damiano Chiari
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Guarneri
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Gian Luca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Elena Mazza
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Sarah Molfino
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
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9
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Chen X, He C, Han D, Zhou M, Wang Q, Tian J, Li L, Xu F, Zhou E, Yang K. The predictive value of Ki-67 before neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis. Future Oncol 2017; 13:843-857. [PMID: 28075166 DOI: 10.2217/fon-2016-0420] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM To review the predictive values of Ki-67 before neoadjuvant chemotherapy (NAC) for breast cancer patients. METHODS PubMed and EMBASE were searched. Random-effect model meta-analysis was conducted using Revman software. RESULTS High Ki-67 was associated with more pathological complete responses (pCRs) events (odds ratio: 3.10; 95% CI: 2.52-3.81; 53 studies, 10,848 patients) regardless of HR+, HER2+ and triple-negative breast cancer types, the definitions of pCR and cut-off points for Ki-67. Ki-67 could predict pCR in those who received anthracyclines plus taxanes, and anthracyclines only, and those from Asia and Europe. CONCLUSION High Ki-67 before NAC was a predictor for pCR in neoadjuvant setting for breast cancer patients.
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Affiliation(s)
- Xianyu Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao He
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Dongdong Han
- Department of Urology, the Second Hospital of Lanzhou University, Lanzhou, China
| | - Meirong Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Quan Wang
- Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Four Military Medical University, Xi'an, Shaanxi, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Lun Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Xu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Enxiang Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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Bonin S, Pracella D, Barbazza R, Sulfaro S, Stanta G. In stage II/III lymph node-positive breast cancer patients less than 55 years of age, keratin 8 expression in lymph node metastases but not in the primary tumour is an indicator of better survival. Virchows Arch 2015; 466:571-80. [PMID: 25724181 DOI: 10.1007/s00428-015-1748-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/20/2015] [Accepted: 02/19/2015] [Indexed: 12/31/2022]
Abstract
Axillary lymph node status is one of the most important prognostic variables for breast cancer (BC). To investigate and understand the clinical, histopathological and biological factors that affect prognosis in node-positive young breast cancer patients, we compared the phenotype of 100 primary tumours with their corresponding loco-regional lymph node (LN) metastases using conventional immunohistochemistry (IHC) markers currently in use for molecular classification of breast cancer. By comparing the expression of ER, PR, HER-2, Ki67, K8, K5/6 and vimentin, we found that expression of HER-2, Ki67, K8 and vimentin is frequently lost in lymph node metastases. Between the primary tumour and corresponding lymph node metastases, expression of keratins K8 and K5/6 significantly changed. Expression of K8 in lymph node metastases, but not in primary tumours, segregates patients in two sub-groups with different outcomes. Survival of patients with K8-positive LN metastases at 5 years in comparison with patients with K8-negative LN metastases was 75 vs 48 %, at 10 years 62 vs 22 % and at 20 years 53 vs 14 % (p < 0.001). K8 immunostaining of tissue from the lymph node metastasis allows defining a sub-group of lymph node-positive BC patients with a highly unfavourable outcome, for whom therapeutic options might have to be reconsidered.
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Affiliation(s)
- Serena Bonin
- Department of Medical Sciences, University of Trieste, Cattinara Hospital, Strada di Fiume 447, Trieste, Italy
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11
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Dong MJ, Wang LB, Jiang ZN, Jin M, Hu WX, Shen JG. The transcription factor KLF4 as an independent predictive marker for pathologic complete remission in breast cancer neoadjuvant chemotherapy: a case-control study. Onco Targets Ther 2014; 7:1963-9. [PMID: 25368523 PMCID: PMC4216037 DOI: 10.2147/ott.s68340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To identify whether a stem cell biomarker, KLF4, may predict the pathologic tumor response to neoadjuvant chemotherapy for patients with locally advanced breast cancer. Methods Twelve locally advanced breast cancer patients who achieved pathologic complete remission (pCR) after neoadjuvant chemotherapy were identified and for each, three non-pCR breast cancer patients – matched for age, clinical tumor–node–metastasis stage, and neoadjuvant chemotherapy cycles – were selected. The relationship between KLF4 expression in the core needle biopsied cancer tissue and patient pCR rate was assessed using univariate and multivariate analysis. Results Receiver operating characteristic curve analysis showed that the patients with a histoscore of KLF4 expression >0.18 had a lower pCR rate. Multivariable analysis showed that higher KLF4 expression (odds ratio 0.013; 95% confidence interval 0.013–0.444; P=0.004) was independently correlated with a lower pCR rate after neoadjuvant chemotherapy. Conclusion KLF4 overexpression was associated with lower pCR in locally advanced breast cancer patients undergoing neoadjuvant chemotherapy. This study suggests that KLF4 may serve as a predictor for pCR in patients with breast cancer after neoadjuvant chemotherapy.
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Affiliation(s)
- Min Jun Dong
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Lin Bo Wang
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Zhi Nong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Mei Jin
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Wen Xian Hu
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Jian Guo Shen
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
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12
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Effect of neoadjuvant chemotherapy on expressions of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 in breast cancer. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Kim KI, Lee KH, Kim TR, Chun YS, Lee TH, Park HK. Ki-67 as a predictor of response to neoadjuvant chemotherapy in breast cancer patients. J Breast Cancer 2014; 17:40-6. [PMID: 24744796 PMCID: PMC3988341 DOI: 10.4048/jbc.2014.17.1.40] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 01/24/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The objectives of this study were to assess the potential value of Ki-67 in predicting response to neoadjuvant chemotherapy in breast cancer patients and to suggest a reasonable cutoff value for classifying Ki-67 expression. METHODS This study included 74 breast cancer patients who underwent surgery after anthracycline-based neoadjuvant chemotherapy between 2007 and 2012. We analyzed the clinical and immunohistochemical characteristics using core biopsy specimens obtained before neoadjuvant chemotherapy to determine their correlations with the response to chemotherapy. RESULTS A clinical complete response was observed in 6 patients (8.1%); a clinical partial response, in 44 patients (59.5%); and clinical stable disease, in 24 patients (32.4%). A pathologic complete response (pCR) was observed in 10 patients (13.5%). In univariate analysis, estrogen receptor (ER) negativity (p=0.031), human epidermal growth factor receptor 2 (HER2) positivity (p=0.040), and high Ki-67 expression (p=0.036) were predictive factors for a pCR. In multivariate analysis, Ki-67 was the only independent predictor of a pCR (p=0.049). The analysis of Ki-67 values revealed that 25% was a reasonable cutoff value for predicting the response to chemotherapy. In subgroup analysis, a higher Ki-67 value (≥25%) was a significant predictive factor for the response to neoadjuvant chemotherapy, especially in ER-negative and HER2-positive breast cancer patients. CONCLUSION Ki-67 expression in breast cancer tissue may be an effective factor for predicting the response to neoadjuvant chemotherapy. We suggest that a 25% level of Ki-67 expression is a reasonable cutoff value for predicting a response to chemotherapy. Moreover, Ki-67 is a useful predictive factor for pCR, especially in patients with ER-negative and HER2-positive breast cancer.
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Affiliation(s)
- Kwan Il Kim
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Kyung Hee Lee
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Tae Ryung Kim
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Yong Soon Chun
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Tae Hoon Lee
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Heung Kyu Park
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
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14
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Pracella D, Bonin S, Barbazza R, Sapino A, Castellano I, Sulfaro S, Stanta G. Are breast cancer molecular classes predictive of survival in patients with long follow-up? DISEASE MARKERS 2013; 35:595-605. [PMID: 24288429 PMCID: PMC3830786 DOI: 10.1155/2013/347073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/25/2013] [Indexed: 12/14/2022]
Abstract
In this study we investigate the clinical outcomes of 305 breast cancer (BC) patients, aged 55 years or younger, with long follow-up and according to intrinsic subtypes. The cohort included 151 lymph node negative (LN-) and 154 lymph node positive (LN+) patients. Luminal A tumors were mainly LN-, well differentiated, and of stage I; among them AR was an indicator of good prognosis. Luminal B and HER2 positive nonluminal cancers showed higher tumor grade and nodal metastases as well as higher proliferation status and stage. Among luminal tumors, those PR positive and vimentin negative showed a longer survival. HER2-positive nonluminal and TN patients showed a poorer outcome, with BC-specific death mostly occurring within 5 and 10 years. Only luminal tumor patients underwent BC death over 10 years. When patients were divided in to LN- and LN+ no differences in survival were observed in the luminal subgroups. LN- patients have good survival even after 20 years of follow-up (about 75%), while for LN+ patients survival at 20 years (around 40%) was comparable to HER2-positive nonluminal and TN groups. In conclusion, in our experience ER-positive breast tumors are better divided by classical clinical stage than molecular classification, and they need longer clinical follow-up especially in cases with lymph node involvement.
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Affiliation(s)
- Danae Pracella
- Department of Medical Sciences, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Serena Bonin
- Department of Medical Sciences, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Renzo Barbazza
- Department of Medical Sciences, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Anna Sapino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Isabella Castellano
- Department of Biomedical Sciences and Human Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Sandro Sulfaro
- Department of Laboratory Medicine, S.C. Pathology, Santa Maria degli Angeli Hospital, 33170 Pordenone, Italy
| | - Giorgio Stanta
- Department of Medical Sciences, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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15
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van Soest RJ, de Morrée ES, Shen L, Tannock IF, Eisenberger MA, de Wit R. Initial biopsy Gleason score as a predictive marker for survival benefit in patients with castration-resistant prostate cancer treated with docetaxel: data from the TAX327 study. Eur Urol 2013; 66:330-6. [PMID: 23957945 DOI: 10.1016/j.eururo.2013.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since 2004, docetaxel has been the standard first-line systemic therapy for patients with metastatic castration-resistant prostate cancer (mCRPC). With abiraterone recently becoming available in the predocetaxel setting, it is warranted to identify subgroups of patients who may obtain the greatest benefit from docetaxel and particularly qualify for receiving docetaxel as first-line treatment for mCRPC. OBJECTIVE We aimed to identify factors that could characterize subgroups of patients who obtain the greatest benefit from the use of docetaxel. DESIGN, SETTING, AND PARTICIPANTS TAX327 was multinational, randomized, phase 3 study that was conducted from 2000 to 2002 in 1006 men with mCRPC. INTERVENTION Patients were randomized to receive docetaxel every 3 wk (D3), weekly docetaxel (D1), or mitoxantrone every 3 wk (M3), each with prednisone. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We investigated whether patients with poorly differentiated tumors (Gleason score ≥7) at diagnosis had greater benefit from D3 compared with M3 than patients with better differentiated tumors (Gleason score ≤6). Using a Cox model, we compared overall survival (OS) between the treatment groups within each subgroup of Gleason score. RESULTS AND LIMITATIONS The TAX 327 data showed that the OS benefit of D3 versus M3 was greater in patients with high-grade tumors (median OS: 18.9 vs 14.5 mo; p=0.009) than in patients with low-grade tumors (median OS: 21.6 vs 20.7 mo; p=0.674). Limitations of a retrospective analysis apply. CONCLUSIONS The survival benefit obtained with docetaxel is most pronounced in patients with high-Gleason-score tumors (Gleason ≥7). In a time of shifting paradigms in mCRPC, with abiraterone becoming available prior to docetaxel chemotherapy, Gleason score may help in selecting patients who obtain the greatest benefit from docetaxel as first-line treatment for mCRPC. Prospective validation of these findings is warranted.
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Affiliation(s)
- Robert J van Soest
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ellen S de Morrée
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Ian F Tannock
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Mario A Eisenberger
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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16
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Meng XL, Su D, Wang L, Gao Y, Hu YJ, Yang HJ, Xie SN. Low expression of stathmin in tumor predicts high response to neoadjuvant chemotherapy with docetaxel-containing regimens in locally advanced breast cancer. Genet Test Mol Biomarkers 2012; 16:689-94. [PMID: 22480216 DOI: 10.1089/gtmb.2011.0298] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We performed this retrospective study to evaluate the value of clinicopathological factors and a novel molecular marker stathmin in predicting treatment response to neoadjuvant chemotherapy (NCT) with docetaxel-containing regimens in patients with locally advanced breast cancer. METHODS Fifty-four consecutive locally advanced patients receiving docetaxel-containing NCT between January 2006 and July 2010 in Zhejiang Cancer Hospital were included. The expression levels of estrogen receptor (ER), progesterone receptor (PgR), epidermal growth factor receptor-2 (HER-2), and p53 were detected by immunohistochemistry, while expression of stathmin mRNA was measured by Quanti-Gene assay. RESULTS The overall clinical objective response (cOR) rate was 75.9% (41/54) in breast. A total of 34 patients (63.0%) experienced pathological OR (pOR), with pathological complete remission (pCR) rate of 20.4% (11/54) in breast and 16.7% (9/54) in both breast and axilla. In univariate analysis, there were associations of pOR in both breast and axilla with age (p=0.054), ER status (p=0.059), subtypes (p=0.062), p53 (p=0.030), and stathmin expression (three terciles) (p=0.039). Mean expression of stathmin in pOR group was 0.410, compared with that in no response group of 0.556 (p=0.051 by Student's t-test). Similarly, a lower expression of stathmin might represent a higher pCR rate (p=0.061). Moreover, the LOWESS smoothing plot showed the same trend, that is, that tumor with a lower level of stathmin expression had a higher probability of response to docetaxel-containing NCT. After multivariate adjustment, both ER and stathmin remained significant with hazard ratio of 4.58 (95% CI: 1.11-18.94, p=0.036) and 2.94 (95% CI: 1.26-6.86, p=0.012), respectively. CONCLUSIONS In conclusion, ER and stathmin were independent predictive factors for NCT with docetaxel-containing regimens.
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Affiliation(s)
- Xu-Li Meng
- Department of Breast Cancer Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
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