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Ann Oncol. 2015 Jan;26(1):75-80. doi: 10.1093/annonc/mdu508. Epub 2014 Oct 30.

Residual proliferative cancer burden to predict long-term outcome following neoadjuvant chemotherapy.

Author information

1
Breast Unit, Royal Marsden Hospital, London Academic Department of Biochemistry, Royal Marsden Hospital, London Breakthrough Breast Cancer Research Centre, London amna.sheri@icr.ac.uk.
2
Breast Unit, Royal Marsden Hospital, London.
3
Clinical Trials and Statistics Unit, Institute of Cancer Research, London.
4
Department of Pathology, Royal Marsden Hospital, London, UK.
5
Division of Medical Oncology, Seattle Cancer Care Alliance, Seattle, USA.
6
Academic Department of Biochemistry, Royal Marsden Hospital, London.
7
Department of Research Oncology, Kings College, London, UK.
8
Department of Pathology, M.D. Anderson Cancer Centre, USA.
9
Breast Unit, Royal Marsden Hospital, London Academic Department of Biochemistry, Royal Marsden Hospital, London Breakthrough Breast Cancer Research Centre, London.

Abstract

BACKGROUND:

The purpose of this study was (i) to test the hypothesis that combining Ki67 with residual cancer burden (RCB) following neoadjuvant chemotherapy, as the residual proliferative cancer burden (RPCB), provides significantly more prognostic information than either alone; (ii) to determine whether also integrating information on ER and grade improves prognostic power.

PATIENTS AND METHODS:

A total of 220 patients treated with neoadjuvant chemotherapy for primary breast cancer were included in the study. Analyses employed a Cox proportional hazard model. Prognostic indices (PIs) were created adding in Ki67, grade and ER to RCB. Leave-one-out cross-validation was used to reduce bias. The overall change in χ(2) of the best model for each index was used to compare the prognostic ability of the different indices.

RESULTS:

All PIs provided significant prognostic information for patients with residual disease following neoadjuvant chemotherapy. RPCB (χ(2) = 61.4) was significantly more prognostic than either RCB (χ(2) = 38.1) or Ki67 (χ(2) = 53.8) alone P < 0.001. A PI incorporating RCB, Ki67 grade and ER provided the most prognostic information overall and gave χ(2) = 73.8.

CONCLUSIONS:

This study provides proof of principle that the addition of post-treatment Ki67 to RCB improves the prediction of long-term outcome. Prediction may be further improved by addition of post-treatment grade and ER and warrants further investigation for estimating post-neoadjuvant risk of recurrence. These indices may have utility in stratifying patients for novel therapeutic interventions after neoadjuvant chemotherapy.

KEYWORDS:

Ki67; breast cancer; neoadjuvant chemotherapy; prognosis; residual disease

PMID:
25361988
DOI:
10.1093/annonc/mdu508
[Indexed for MEDLINE]

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