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

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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.

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Authors and Affiliations

  1. Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK

    Robin L. Jones, Janine Salter & Mitchell Dowsett

  2. Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, Surrey, UK

    Roger A’Hern

  3. Breast Unit, Royal Marsden Hospital, London, UK

    Ash Nerurkar, Marina Parton & Ian E. Smith

  4. Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK

    Jorge S. Reis-Filho

Authors
  1. Robin L. Jones
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  2. Janine Salter
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  3. Roger A’Hern
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  4. Ash Nerurkar
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  5. Marina Parton
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  6. Jorge S. Reis-Filho
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  7. Ian E. Smith
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  8. Mitchell Dowsett
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Correspondence to Mitchell Dowsett.

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Jones, R.L., Salter, J., A’Hern, R. et al. The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer. Breast Cancer Res Treat 116, 53–68 (2009). https://doi.org/10.1007/s10549-008-0081-7

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  • DOI: https://doi.org/10.1007/s10549-008-0081-7

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