Abstract
The preoperative endocrine prognostic index (PEPI) predicts survival after neoadjuvant endocrine therapy (NAE) using aromatase inhibitors (AIs) for women with postmenopausal estrogen receptor (ER)-positive breast cancer irrespective of the human epidermal growth factor receptor 2 (HER2) status. Although the progesterone receptor (PgR) is also a prognostic factor for ER-positive breast cancer, the PgR status was not considered a prognostic factor in the original PEPI scoring system. In this study, we investigated the utility of a modified PEPI including the PgR status (PEPI-P) as a prognostic factor after NAE for postmenopausal patients with ER-positive and HER2-negative breast cancer. We enrolled 107 patients with invasive ER-positive and HER2-negative breast cancer treated with exemestane for ≥4 months as NAE. We initially assessed PEPI and compared survival between the groups. Additionally, we obtained an effective cutoff for PgR through survival analysis. Then, we assessed the survival significance of PEPI-P. A PgR staining rate of 50% was the most significant cutoff for predicting recurrence-free survival (RFS) and cancer-specific survival (CSS). PEPI was a significant prognostic factor; moreover, PEPI-P was the most significant prognostic indicator for RFS and CSS. PEPI-P is a potent prognostic indicator of survival after NAE using AIs for postmenopausal patients with ER-positive and HER2-negative breast cancer. This modified PEPI may be useful for therapeutic decision-making regarding postmenopausal ER-positive and HER2-negative breast cancer after NAE.
Highlights
In both clinical studies and routine practice, neoadjuvant endocrine therapy (NAE) is considered a valid therapeutic option for postmenopausal patients with operable estrogen receptor (ER)-positive breast cancer
A study illustrated that the progesterone receptor (PgR) status can indicate a poor prognosis in patients with ER-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer [8]
This study revealed that p-PgR expression was a significant prognostic factor for NAE using exemestane, and the best cutoff for p-PgR was 50%
Summary
In both clinical studies and routine practice, neoadjuvant endocrine therapy (NAE) is considered a valid therapeutic option for postmenopausal patients with operable estrogen receptor (ER)-positive breast cancer. Using aromatase inhibitors (AIs), NAE has proven to effectively decrease tumor size in postmenopausal patients with ER-positive breast cancer. In the St. Gallen consensus meeting, NAE without chemotherapy was suggested as a practical option for postmenopausal patients with endocrine therapy-responsive tumors [6]. To assess patients’ outcomes, Ellis et al [7] proposed a scoring system, the preoperative endocrine prognostic index (PEPI), consisting of the pathological tumor size, pathological node status, Ki67 labeling index, and ER status of residual tumors after NAE. Because the PgR status was not included in the original PEPI scoring system, the utility of PgR expression in primary tumors (p-PgR) as a prognostic factor for patients who received NAE remains unclear
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