乳腺癌分子亚型和Ki67表达对中国人群新辅助化疗预后和效果预测的价值

　　2016年5月，威科集团LWW旗下《医学》（巴尔的摩）发表了中国医学科学院北京协和医学院附属肿瘤医院的研究报告：乳腺癌分子亚型和Ki67表达对中国人群新辅助化疗预后和效果预测的价值（通讯作者为徐兵河教授@BC冰河时代）。

　　该研究发现管腔A型患者对新辅助化疗的获益最少，但有较好长期预后，雌激素受体状态和Ki67表达可以作为新辅助化疗效果的预测指标，而仅Ki67表达＞40%与长期治疗结局相关。

Medicine (Baltimore). 2016 May;95(18):e3518.

Value of Breast Cancer Molecular Subtypes and Ki67 Expression for the Prediction of Efficacy and Prognosis of Neoadjuvant Chemotherapy in a Chinese Population.

Wang J, Sang D, Xu B, Yuan P, Ma F, Luo Y, Li Q, Zhang P, Cai R, Fan Y, Chen S, Li Q.

Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuannanli, Chaoyang District, Beijing, China.

The aim of the study was to determine the predictive role of breast cancer subtypes in the efficacy and prognosis of neoadjuvant chemotherapy (NCT) regimens combining taxanes and anthracyclines.

Data from 240 patients with breast cancer who received surgery after 4 to 6 weeks of NCT were retrospectively analyzed. The patients were classified into luminal A, luminal B, HER2 overexpression, and triple negative breast cancer (TNBC) as well as low Ki67 (≤ 14%) and high Ki67 (> 14%) expression groups using immunohistochemistry. NCT outcome parameters were pathological complete response (pCR), clinical complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) 4 weeks after surgery. Long-term outcome parameters were disease-free survival (DFS) with a follow-up time of 3 to 56 months.

pCR rates were 1.6%, 13.4%, 22.6%, and 23.8% in patients with luminal A, luminal B, HER2, and TNBC cancers, respectively. High pCR rates correlated with high Ki67 expression (> 40%) (P < 0.001, HR = 0.17, 95% CI: 0.074-0.37) and negative estrogen receptor (ER) status (P < 0.001, HR = 3.74, 95% CI: 1.71-8.12) in a multivariate analysis. However, the DFS rate of luminal A breast cancer was the highest compared to all other groups, but only significantly higher compared to luminal B (P = 0.035, HR = 1.480, 95% CI: 1.060-1.967) patients and correlated with Ki67 expression > 40% (P = 0.005).

Luminal A type patients derived the least benefit from neoadjuvant chemotherapy but had better long-term prognoses. ER status and Ki67 expression served as efficacy predictors for NCT, whereas only Ki67 expression > 40% correlated with long-term treatment outcomes.

PMID: 27149453

DOI: 10.1097/MD.0000000000003518