| Purpose:This study was conducted to analyze the Ki-67 expression before and after neoadjuvant chemotherapy(NAC) and clinical pathology characteristics of different biological breast cancer phenotypes at our center. A correlation study was performed between Ki-67 index change and the prognosis of different biological breast cancer phenotypes and prognosis in Northern China.Methods:A regression analysis was performed on 213 patients with invasive breast carcinoma accepted NAC admitted to Tianjin Medical University Cancer Institute and Hospital of Breast Surgery from January 2007 to April 2008. These patients were subtyped by hormone receptor status and HER2 status.The Ki67 index(percentage of Ki67-positive cancer nuclei) were determined immunohistochemically. The prognostic value of the Ki-67 index for different biological breast cancer phenotypes disease-free survival(DFS) and overall survival(OS) was investigated by use of Kaplan–Meier curves and multivariable Cox regression. Results:The overall Pathologic CR(p CR) rate, defined as no invasive residuals in breast and axilla, was 17.8%. The highest p CR rate of 32.1% was observed in patients with HR-/HER2+ tumors,which is 11.4%,20.0% and 26.2% in HR+/HER2- HR+/HER2-,HR+/HER2+and HR-/HER2- tumor respectively(P = 0.024).The Ki-67 expression of pre-NAC and post-NAC have prognostic significance in HER2- breast cancer, which have not significance different in HER2+ breast cancer:The best Ki-67 idex cut point of pre-NAC and post-NAC to predict long-term survival was respectively 20% and 10% in HR+/HER2- breast cancer. Moreover, patients with a higher Ki-67 index(> cut-off point) showed significantly lower 5year-DFS/OS rates compared with those whose Ki-67 index were below cut-off point. In addition, Ki-67 index of post-NAC were independent prognostic factors for 5 year disease-free survival of patients with HR+/HER2- breast cancer. Ki-67 change between pre- and post-NAC as an independent prognostic factor independently predict prognosis in the patients who have not achieved p CR, while the best cut-off point was 18%.Conclusion The p CR rate after neoadjuvant chemotherapy in type HR-/HER2+patients with breast cancer was more significant, but in type HR+/HER2-breast cancer p CR is low. The recurrence and metastasis rate in HR-/HER2- and HR-/HER2+ type of breast cancer patients is higher compared to the HR+/HER2- and HR+/HER2+ type. Not at the molecular type can not guide operation mode selection and whether you will need the guidance received adjuvant radiotherapy. The Ki-67 index before and after neoadjuvant chemotherapy correlates to 5 year disease free survival in overall breast cancer patients and HR+/HER2- breast cancer. The Ki-67 index after neoadjuvant chemotherapy correlates to 5 year disease free survival HR-/HER2- type of breast cancer. For HR+/HER2- type of breast cancer, the best cut-off point before and after neoadjuvant chemotherapy is 20% and 10%, respectively.The patients of Ki-67 below the value in DFS and OS was better than that of patients with Ki-67 higher,the higher Ki-67 the worse prognosis. For HR-/HER2- type of breast cancer patients, Ki-67 value cannot be used to predict the prognosis of patients. The change of Ki-67 before and after neoadjuvant chemotherapy is the independent survival factors affecting the non p CR patients with breast cancer. The Ki-67 reduse before and after neoadjuvant chemotherapy. In patients with non p CR breast cancer only in HR+/HER2+ type of breast cancer patients, the reduce value of Ki-67 relates to the disease free survival,and the best cut-off of Ki-67 reduse after neoadjuvant chemotherapy is 18%.Beyond this, non p CR breast cancer can benefit from 5 year disease free survival and over survival. |
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