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Breast Cancer Res Treat. 2009 Jul;116(1):53-68. doi: 10.1007/s10549-008-0081-7. Epub 2008 Jul 1.

The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer.

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  • 1Academic Department of Biochemistry, Royal Marsden Hospital, London, UK.

Abstract

PURPOSE:

To compare the prognostic significance of proliferation, as assessed by Ki67 expression, in breast cancer before and after neoadjuvant chemotherapy.

METHODS:

A retrospective search of a prospectively maintained clinical database was performed to identify patients treated with neoadjuvant chemotherapy at the Royal Marsden Hospital. The expression of Ki67 was assessed using immunohistochemistry in pre-therapy core-needle biopsy and post-therapy surgical excision specimens. The following factors were considered pre- and post-chemotherapy for their relationship with relapse-free and overall survival: age, menstrual status, T and N stage, pre-therapy operability, Ki67, ER, PgR, HER2, grade, histological subtype, vascular invasion, clinical response, chemotherapy regimen, type of surgery performed, adjuvant therapy, pathological tumour size and nodal involvement.

RESULTS:

In a matched cohort of 103 patients, on multivariate analysis of relapse-free survival, post-therapy Ki67 was the only significant independent prognostic factor. On multivariate analysis for overall survival, both pre- and excision Ki67 were significant independent predictors but the latter showed a stronger prognostic impact. The highest and lowest tertiles of excision Ki67 had different prognosis for both 5-year relapse-free (27% vs. 77%) and overall (39% and 93%) survival. In a cohort of 284 patients with only excision samples, post-therapy Ki67 was a significant independent prognostic factor on multivariate analysis.

CONCLUSION:

Post-chemotherapy Ki67 is a strong predictor of outcome for patients not achieving a pathological complete response.

PMID:
18592370
[PubMed - indexed for MEDLINE]
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