演題

Utility of Ki67 labeling index(LI)in predicting marked pathological response to neoadjuvant chemo-endocrine therapy in postmenopausal estrogen receptor(ER)-positive breast cancer

[演者] 黒住 献:1
[著者] 井上 賢一:2, 山口 ゆり:3, 松本 広志:1, 林 祐二:1, 戸塚 勝理:1, 蓬原 一茂:4, 君塚 圭:5, 小松 恵:1, 大庭 華子:6, 堀口 淳:7, 竹吉 泉:7, 黒住 昌史:6
1:埼玉県立がんセンター乳腺外科, 2:埼玉県立がんセンター乳腺腫瘍内科, 3:埼玉県立がんセンター臨床腫瘍研究所, 4:自治医科大学さいたま医療センター外科, 5:春日部市立病院外科, 6:埼玉県立がんセンター病理診断科, 7:群馬大学臓器病態外科

Background: Luminal B-like (ER-positive and high-Ki67 LI) breast cancer (BC) has been recommended to receive adjuvant chemo-endocrine therapy. In this prospective study, we investigated relationships between alteration of Ki67 LI and pathological response as well as survival after neoadjuvant chemo-endocrine therapy.Methods: Forty-six Japanese postmenopausal ER-positive invasive BC with tumors larger than 2 cm or positive lymph node, were enrolled. Only exemestane (25 mg/day) was administered for 2 months, and 4 cycles of doxorubicin (50 mg/m2) plus paclitaxel (150 mg/m2) followed by weekly paclitaxel (80 mg/m2) were added as neoadjuvant chemo-endocrine therapy. Ki67 LI at pre-treatment, post-exemestane alone, and post-neoadjuvant chemo-endocrine therapy were evaluated. Marked pathological response was defined as pCR (no invasive cancer) or two-third reduction of cancer.Results: Marked pathological responses (including 6.5% of pCR) were obtained in 34.8% of patients: in 45.7% of Luminal B-like (Ki67 more than 14%) and 0% of Luminal A-like (Ki67 under 14%) groups (p=0.005), but no significant difference in RFS between two groups (median follow-up: 48 months) was recognized. High-Ki67 (more than 14%) was observed 76.1% of cases at pre-treatment,but decreased to 38.7% after exemestane alone treatment and 8.7% after chemo-endocrine therapy (p<0.001). Marked response was more likely to be recognized in high-Ki67 group than low-Ki67 group after exemestane alone treatment (50.0% vs. 35.0%).Conclusions: In neoadjuvant setting, chemo-endocrine therapy might also yield marked pathological response over 30% and Ki67 LI might be a useful predictor of response in this therapy.
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