Abstract
This study was to investigate the prognostic role of Ki-67 in further classification of triple negative breast cancer (TNBC), and to test whether high expression level of Ki67 can predict benefit from carboplatin. From January 2004 to December 2012, 363 patients operated for TNBC were identified through the institutional clinical database. After a median follow-up time of 34 months (5.2–120.0 months), 62 patients (17.1%) had relapses and 33 patients (9.1%) died of breast cancer. In univariate analysis, high Ki-67 index as well as larger tumor size and lymph node involvement was associated with shorter disease-free survival (DFS) and overall survival (OS). In multivariate analysis, high Ki-67 is an independent risk factor for DFS (Risk Ratio, RR: 2.835, 95% confidence interval, 95% CI: 1.586–5.068, P < 0.001) and OS (RR: 3.180, 95% CI: 1.488–6.793, P = 0.003). When analyzing the 3-year DFS by Ki-67 distribution, Subpopulation Treatment Effect Pattern Plot analysis showed a beneficial effect of carboplatin in patients with high Ki-67 index. In conclusion, TNBC is probably a heterogeneous disease with different characteristics and prognosis, and may be further subdivided according to the Ki-67 expression levels. Patients in the high Ki- 67 group seem to benefit more from treatment with carboplatin, but this needs to be further verified.
Highlights
Triple negative breast cancer (TNBC) is a subgroup of breast cancer lacking estrogen receptor (ER) and progesterone receptor (PR) expression as well as human epithelial growth factor receptor 2 (HER2) amplification
triple negative breast cancer (TNBC) is a group of tumors with poor prognosis because of aggressive tumor biology and lack of targeted agents [16]
Better understanding of its biological behavior is essential to improve the outcomes for TNBC patients
Summary
Triple negative breast cancer (TNBC) is a subgroup of breast cancer lacking estrogen receptor (ER) and progesterone receptor (PR) expression as well as human epithelial growth factor receptor 2 (HER2) amplification. TNBC is a common immunohistochemical (IHC) status for a number of tumors with heterogeneous clinical presentations [1]. Recent study identified six TNBC subtypes that display unique profiles [2]. Given the biological diversity within TNBC, it is essential to identify subtypes with a better prognosis which may be spared intensive adjuvant therapy, and those in greatest need of more aggressive regiments. An important cellular function, is closely related to tumor behavior in breast cancer [3]. Ki-67 is one of the most widely used IHC proliferation antigen and has been confirmed as an independent predictive and prognostic factor in early breast cancer [4, 5]. While the prognostic value of the Ki-67 level in TNBC is yet unclear
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