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- Title
Neoadjuvant Chemotherapy and Pathologic Complete Response in HR+/HER2− Breast Cancer: Impact of Tumor Ki67 and ER Status.
- Authors
Akdag, Goncagul; Yildirim, Sedat; Dogan, Akif; Yuksel Yasar, Zeynep; Bal, Hamit; Kinikoglu, Oguzcan; Oksuz, Sila; Ozkerim, Ugur; Tunbekici, Salih; Yildiz, Hacer Sahika; Turkoglu, Ezgi; Alan, Ozkan; Coban Kokten, Sermin; Isik, Deniz; Sever, Ozlem Nuray; Odabas, Hatice; Yildirim, Mahmut Emre; Turan, Nedim
- Abstract
Introduction: Neoadjuvant chemotherapy (NAC) is extensively employed in breast cancer (BC), primarily for aggressive subtypes like triple-negative and human epidermal growth factor receptor 2 (HER2)-positive BC and in estrogen receptor-positive (ER+)/HER2− BC with high-risk features. In ER+/HER2− BC, pathological complete rates are much lower (<10%), while axillary dissection rates are higher. This study focuses on hormone receptor-positive (HR+)/HER2− BC patients undergoing NAC, examining its impact on pathological complete response (pCR) rates, with specific attention to tumor Ki67 and ER status. Methods: Retrospective data analysis from Kartal Dr. Lütfi Kırdar City Hospital included HR+/HER2− BC patients who received NAC. Clinicopathological factors, NAC response, and surgical outcomes were assessed. Statistical analyses evaluated the association between Ki67, ER status, and pCR. Results: Of 203 patients, 11.8% achieved pCR. Ki67 (p < 0.001) and ER percentage (p < 0.001) significantly correlated with pCR. Higher Ki67 was associated with increased pCR likelihood (HR: 1.03, 95% CI: 1.01–1.05). A Ki67-pCR probability curve revealed a cutoff of 23.5%. ER%-pCR analysis showed decreasing pCR rates with higher ER percentages. Multivariate analysis confirmed Ki67 (p = 0.003, HR: 1.02) and ER percentage (p = 0.019, HR: 0.97) as independent predictors of pCR probability. Conclusion: Consideration of Ki67 and ER percentage aids in NAC decisions for HR+/HER2− BC, identifying patients with high NAC response rates, facilitating axillary preservation, and potentially avoiding axillary dissection. The pCR rates in patients with Ki67 ≤24 are particularly low, especially in patients with a high ER percentage. In these cases, upfront surgery and adjuvant treatment should be considered instead of NAC.
- Subjects
PATHOLOGIC complete response; EPIDERMAL growth factor receptors; NEOADJUVANT chemotherapy; ESTROGEN receptors; URBAN hospitals; HORMONE receptor positive breast cancer
- Publication
Chemotherapy (0009-3157), 2024, Vol 69, Issue 3, p141
- ISSN
0009-3157
- Publication type
Article
- DOI
10.1159/000537874