Background
Ki67 has been identified as a prognostic and predictive marker for breast cancer and
it was suggested that it may contribute to pathologic complete response (pCR) after
neoadjuvant chemotherapy. It is unclear whether expression of Ki67 is particularly
helpful for prediction of pCR across tumor subtypes.
Methods
Pretherapeutic Ki67 was evaluated in a series of 121 breast cancer core biopsies.
After neoadjuvant chemotherapy, we used postoperative specimens to evaluate the pCR
status. Several parameters predictive of pCR were identified using logistic regression
analysis. We investigated subgroups defined by estrogen receptor (ER), progesterone
receptor, and human epidermal growth factor receptor 2, in which predicting pCR with
Ki67 might be feasible.
Results
Ki67 was found to be an independent predictor of pCR in multivariate analysis (odds
ratio [OR], 3.62; 95% CI, 1.21–10.8). When stratified by ER, the above significance
was exclusive to ER-positive tumors (OR, 6.24; 95% CI, 1.40–27.7). Using an receiver-operating
characteristic curve, we obtained moderate discriminative accuracy with an area under
the curve of 0.7752 for Ki67 prediction of pCR in ER-positive tumors. In subgroup
analysis, patients with high Ki67 showed significantly improved pCR rate in luminal-type
disease, with a median Ki67 value of 43% in the patients who achieved pCR, versus
29% for those without pCR (P = .018), whereas no associations were observed in other subtypes.
Conclusion
Our results suggest that stratification according to Ki67 levels might improve predictive
significance of the response in hormone-responsive breast cancer. Even in these subtypes
assumed to be less chemosensitive, some patients with highly proliferative tumors
derive a significant benefit from chemotherapy, and consequently it is important to
identify them.
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Article info
Publication history
Published online: February 07, 2014
Accepted:
January 31,
2014
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
