Ki-67 can be used for further classification of triple negative breast cancer into two subtypes with different response and prognosis

Abstract

IntroductionTriple negative breast cancer (TNBC) has a poorer survival, despite a higher response rate to neoadjuvant chemotherapy. The purpose of this study was to identify the predictive or prognostic value of Ki-67 among patients with TNBC treated with neoadjuvant chemotherapy, and the role of Ki-67 in further classification of TNBC.MethodsA total of 105 TNBC patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were included in the present study. Pathologic complete response (pCR) rate, relapse-free survival (RFS), and overall survival (OS) were compared according to the level of Ki-67.ResultspCR was observed in 13.3% of patients. TNBC with high Ki-67 expression (≥10%) showed a higher pCR rate to neoadjuvant chemotherapy than TNBC with low Ki-67 expression. None of the low Ki-67 group achieved pCR (18.2% in the high Ki-67 group vs. 0.0% in the low Ki-67 group, P = 0.019). However, a high Ki-67 expression was significantly associated with poor RFS and OS in TNBC, despite a higher pCR rate (P = 0.005, P = 0.019, respectively). In multivariate analysis, high Ki-67 was an independent prognostic factor for RFS in TNBC (hazard ratio = 7.82, P = 0.002). The high Ki-67 group showed a similar pattern of recurrence with overall TNBC, whereas the low Ki-67 group demonstrated a relatively constant hazard rate for relapse.ConclusionsTNBC with high Ki-67 was associated with a more aggressive clinical feature despite a higher pCR rate. High proliferation index Ki-67 can be used for further classification of TNBC into two subtypes with different responses and prognosis.

Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico

“…This is in agreement with data in the literature, which show that, in such patients, the tumor is more aggressive, the incidence of distant metastases, particularly in visceral organs such as the lung, is higher, and survival is lower. (5,11,(15)(16)(17)(18) We found that there was a tendency toward a worse prognosis in patients who had been diagnosed with a primary tumor before 50 years of age, perhaps suggesting that diagnosis after the age of 50 is a protective factor. The prognosis for breast cancer is relatively good if it is diagnosed in the early stages.…”

“…(18,24,25) The worst breast cancer survival rates are in developing countries. (26,27) Survival in malignant pleural effusion has also been widely studied.…”

Associations Between Mammography and Ultrasound Imaging Features and Molecular Characteristics of Triple-negative Breast Cancer

“…There is no report about the relationship between these two factors and TNBC imaging features. Keam et al (2011) reported that a high Ki-67 expression was significantly associated with poor RFS and OS in TNBC, regardless of the pathologic complete response (PCR). This finding is similar for p53 in TNBC (Chae et al, 2009), which when positive or overexpressed, resulted in non-ideal or poor RFS and OS.…”

“…The overall survival (OS)rate is lower in the p53 (+) group than in the p53 (-) group (Chae et al, 2009). A high Ki-67 expression is associated with poor relapse-free survival (RFS) and OS in TNBC (Keam et al, 2011). TNBC accounts for 11%-20% of all sub-types of breast cancer (Itoh et al, 2006).…”

“…Ki-67 was calculated by counting the percentage of stained Ki-67 positive cells among the total number of counted tumor cells. We considered Ki-67 positive when ≥10% and negative when <10% (Keam et al, 2011).…”