Ki67 Measured after Neoadjuvant Chemotherapy for Primary Breast Cancer

医学 乳腺癌 内科学 长春瑞滨 化疗 环磷酰胺 肿瘤科 多西紫杉醇 新辅助治疗 危险系数 卡培他滨 癌症 胃肠病学 置信区间 顺铂 结直肠癌
作者
Gϋnter von Minckwitz,Wolfgang Schmitt,Sibylle Loibl,Berit Müller,Jens-Uwe Blohmer,Bruno Valentin Sinn,Holger Eidtmann,W. Eiermann,Bernd Gerber,Hans Tesch,J. Hilfrich,Jens Huober,Tanja Fehm,Jana Barinoff,Thomas Rüdiger,Erhard Erbstoesser,Peter A. Fasching,Thomas Karn,Volkmar Müller,Christian Jackisch,Carsten Denkert
出处
期刊:Clinical Cancer Research [American Association for Cancer Research]
卷期号:19 (16): 4521-4531 被引量:141
标识
DOI:10.1158/1078-0432.ccr-12-3628
摘要

Abstract Purpose: The value of Ki67 measured on residual disease after neoadjuvant chemotherapy is not sufficiently described. Experimental Design: Participants of the GeparTrio study with primary breast cancer randomly received neoadjuvant response-guided [8 cycles TAC (docetaxel/doxorubicin/cyclophosphamide) in responding and TAC-NX (vinorelbine/capecitabine) in nonresponding patients] or conventional (6 cycles TAC) chemotherapy according to interim response assessment. Ki-67 levels were centrally measured immunohistochemically after neoadjuvant treatment if tumor tissue was available. Here, we analyze 1,151 patients having a pathologic complete response (pCR; n, 484), or residual disease with low (0–15%), intermediate (15.1–35%), or high (35.1–100%) posttreatment Ki67 levels in 488, 77, and 102 patients, respectively. Results: Patients with high posttreatment Ki67 levels showed higher risk for disease relapse (P < 0.0001) and death (P < 0.0001) compared with patients with low or intermediate Ki67 levels. Patients with low Ki67 levels showed a comparable outcome to patients with a pCR (P = 0.211 for disease-free and P = 0.779 for overall survival). Posttreatment Ki67 levels provided more prognostic information than pretreatment Ki67 levels or changes of Ki67 from pre- to posttreatment. Information on pCR plus posttreatment Ki67 levels surmount the prognostic information of pCR alone in hormone–receptor-positive disease [hazard ratios (HR), 1.82–5.88] but not in hormone–receptor-negative disease (HR: 0.61–1.73). Patients with conventional and response-guided treatment did not show a different distribution of posttreatment Ki67 (P = 0.965). Conclusions: Posttreatment Ki67 levels provide prognostic information for patients with hormone–receptor-positive breast cancer and residual disease after neoadjuvant chemotherapy. Levels were not prognostic for outcome after response-guided chemotherapy. High posttreatment Ki67 indicates the need for innovative postneoadjuvant treatments. Clin Cancer Res; 19(16); 4521–31. ©2013 AACR.
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