Abstract. the choice of adjuvant systemic therapy is based on targeted therapy in line with the St. Gallen consensus meeting. in addition to the traditional parameters, the panel recommended the use of proliferation markers and multigene assays. the purpose of the present study was to evaluate the clinical significance of proliferative activity using the Ki-67 index as a prognostic marker and as a predictor of recurrence time in breast cancer patients. The Ki-67 index was measured in 3,652 cases with primary breast cancer from 1987 to 2009. Out of these patients, 2,638 cases were evaluated simultaneously for estrogen receptor, progesterone receptor and hEr2 from 1997, and these were analyzed as a prognostic factor according to their subtypes. The Ki-67 index exhibited a wide range of 1-99%, with a median of 20%, and cases were divided into 2 or 3 index groups; <20% and ≥20% (and ≥50%). The median Ki-67 index of tumors with luminal A was 17%, and that of luminal B type tumors was 29%. The Ki-67 index of HER2 tumors was 40% and that of triple negative tumors was 50%. A higher Ki-67 index significantly correlated with a higher grade of malignancy. Patients with a higher Ki-67 index had significantly lower disease-free survival (DFS) and overall survival rates. Moreover, there was a significant difference in the recurrence time. multivariate analysis revealed that the Ki-67 index was a significant factor for DFS, irrespective of nodal status, and that Ki-67 was a significant marker only in luminal A type tumors. Furthermore, luminal A type cases with high Ki-67 had a similar DFS as the luminal B type cases. A higher Ki-67 index (≥20%) significantly correlated with other biological markers, poorer prognosis and early recurrence, particularly in luminal a type tumors. it is important to take the Ki-67 index into consideration in the treatment and follow-up of breast cancer patients.
Introductionrecently, research on the biology of breast cancer has made surprising progress. an attempt to understand the unique biological characteristics of individual tumors to facilitate treatment has been realized. At present, treatment strategy is, not only based on the stage classification, but also on tumor biology. the St. Gallen international Expert consensus on the primary therapy of early breast cancer outlines the guidelines for endocrine and chemotherapy treatment (1). The treatment allocation mainly consists of targeted treatments, such as endocrine therapy for estrogen receptor (ER)-positive tumors and anti-hEr2 therapy for hEr2-positive tumors. chemotherapy is recommended for triple negative (TN) tumors that have no targets. at present, the vital problem is how to incorporate chemotherapy into the treatment of hormone-sensitive patients with Er-positive and hEr2-negative tumors, as they make up the majority of the patients with primary breast cancer. One solution is to consider the Ki-67 index when deciding the method of treatment.Ki-67 is present in all proliferating cells, and there is great interest in its role as a pro...
The Ki-67 value before NAC was a significant predictive factor for the effectiveness of NAC. The Ki-67 values after NAC significantly decreased and correlated with clinical response and DFS. Therefore, higher Ki-67 values (≥ 25%) before NAC as well as lower values (<12%) after NAC might be clinically significant for treating patients.
This study included patients with primary triple-negative breast cancer (TNBC) who underwent resection without neoadjuvant chemotherapy between January 2004 and December 2014. Among the 248 TNBCs studied, programmed cell death ligand-1 (PD-L1) expression was detected in 103 (41.5%) tumors, and high levels of tumor-infiltrating lymphocytes (TILs) were present in 118 (47.6%) tumors. PD-L1 expression correlated with high levels of TILs, but was not a prognostic factor. Patients with TILs-high tumors had better overall survival than those with TILs-low tumors (P = 0.016). There was a strong interaction between PD-L1 expression and TILs that was associated with both recurrence-free survival (P = 0.0018) and overall survival (P = 0.015). Multivariate Cox proportional hazards model analysis showed that PD-L1-positive/TILs-low was an independent negative prognostic factor for both recurrence-free survival and overall survival. Our findings suggest that PD-L1-positive/TILs-low tumors are associated with a poor prognosis in patients with TNBC, and that it is important to focus on the combination of PD-L1 expression on tumor cells and TILs present in the tumor microenvironment. These biomarkers may be useful for stratification of TNBCs and for predicting prognosis and developing novel cancer immunotherapies.
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