Abstract
To identify the biomarkers of response to neoadjuvant chemotherapy in early luminal breast cancer. A cross-sectional study that included all patients with early or locally-advanced luminal breast cancer submitted to neoadjuvant chemotherapy between 2013 and 2014. Demographic, clinic and pathologic data were retrieved from patient records. The expressions of the estrogen receptor (ER), the progesterone receptor (PR), and Ki67 were analyzed by immunohistochemistry (IHC). The status of the human epidermal growth factor receptor 2 (HER2) was evaluated by IHC and fluorescent in situ hybridization (FISH). Independent predictors of clinic and pathologic response were evaluated by stepwise logistic regression models and receiver operating characteristic (ROC) curve analysis. Out of 298 patients identified, 115 were included in the analysis. Clinical complete response (cCR) was observed in 43.4% of the patients (49/113), and pathologic complete response (pCR) was observed in 7.1% (8/115) of the patients. The independent predictors of cCR were premenopausal status (p < 0.001), low PR expression (≤ 50% versus > 50%; p = 0.048), and Ki67 expression ≥ 14% (versus < 14%; p = 0.01). Patients with cCR were more commonly submitted to breast conserving surgery (34.7% versus 7.8%; p < 0.001). Increasing cut-off points for Ki67 expression were associated with an increase in specificity and a decrease in sensitivity to identify patients with cCR. Premenopausal status, lower PR expression and higher Ki67 expression were associated with a higher rate of cCR to neoadjuvant chemotherapy in luminal breast cancer.
Highlights
MethodsBreast cancer is a heterogeneous group of diseases that differ in terms of behavior, prognosis and response to treatment.[1,2] Traditional prognostic and predictive markers, such as tumor size, lymph-node involvement, vascular invasion, and expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are used to select the treatment
Premenopausal status, lower PR expression and higher Ki67 expression were associated with a higher rate of Clinical complete response (cCR) to neoadjuvant chemotherapy in luminal breast cancer
Os fatores preditivos independentes de Resposta clínica completa (RCc) foram status menopausal (p < 0.001), baixa expressão de receptor de progesterona (RP) ( 50% versus > 50%; p 1⁄4 0.048), e expressão de Ki67 ! 14%
Summary
MethodsBreast cancer is a heterogeneous group of diseases that differ in terms of behavior, prognosis and response to treatment.[1,2] Traditional prognostic and predictive markers, such as tumor size, lymph-node involvement, vascular invasion, and expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are used to select the treatment. Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) is considered a surrogate endpoint for long-term outcomes.[6,7] pCR is rarely seen in hormone-receptor-positive (luminal) breast cancer, and its prognostic impact is not clear.[8,9] Still, a subgroup of luminal tumors is chemosensitive.[10,11] There is a need to identify predictive factors that could help select patients with luminal breast cancer who would benefit from NAC
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