Journal of the National Cancer Institute Advance Access originally published online on June 27, 2007
JNCI Journal of the National Cancer Institute 2007 99(13):1053; doi:10.1093/jnci/djm019
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Published by Oxford University Press 2007.
CORRESPONDENCE |
Re: Prognostic Value of Ki67 Expression After Short-Term Presurgical Endocrine Therapy for Primary Breast Cancer
Affiliations of authors: Cancer Chronobiology Laboratory, Dorn Department of Veterans Affairs Medical Center, Columbia, SC (WJMH); Department of Vascular Biology, Children's Hospital and Harvard Medical School, Boston, MA (MR); Department of Oncology, University College London Medical School, London, UK (MB); Department of Medical Oncology, Istituto Nazionale Tumori, Milan, Italy (RD)
Correspondence to: William J. M. Hrushesky, MD, Cancer Chronobiology Laboratory, Dorn Department of Veterans Affairs Medical Center, Bldg 9 Research, 6439 Garners Ferry Rd, Columbia, SC 29209 (e-mail: william.hrushesky{at}va.gov)
In a recent study, Dowsett et al. (1) reported that among postmenopausal patients with breast cancer, the proportion of tumor cells expressing Ki67 after 2 weeks of endocrine therapy predicted recurrence after resection better than the proportion of cells expressing Ki67 before initiation of endocrine therapy.
The authors compared Ki67 expression and other tumor cell characteristics in pairs of tumor biopsy samples. One sample in each pair was obtained by a core-needle biopsy of the primary tumor. The second sample was obtained during surgical resection of the primary tumor that was performed 2 weeks after the first sample was obtained. The authors found that the Ki67 values of the second sample predicted local and distant breast cancer recurrences better than the Ki67 values of the first sample. The authors claimed that the differences in the predictive capacity of Ki67 results arose as a result of 2 weeks of treatment with one of three endocrine therapies given between the first and second tissue sampling. This conclusion is not warranted.
We have shown that surgical trauma associated with breast cancer resection may be responsible for changing the dynamics of cancer recurrence and dissemination after resection (2–4). Badwe et al. (5) have shown that comparable effects on outcome occur after core-needle biopsy.
A core-needle biopsy, in which two or three cores of a tumor are taken, is a traumatic event. This procedure results in intratumoral and peritumoral bleeding and the resulting wound healing dynamic within the tumor bed has systemic effects.
It is possible that changes in biologic markers that are measured within a tumor nodule 2 weeks after a large-bore needle has been repeatedly passed through it may be associated with the 2 weeks of endocrine therapy that follows this wound. However, it is also possible that values of such measurements may be associated with either the wounding itself or the interaction of this surgical wounding with the endocrine therapy. It is important to differentiate between these two possibilities because modulation of the effects of surgical wounding upon subsequent cancer spread may be an important strategy to increase the curability of breast cancer, which should not be ignored (6).
REFERENCES
(1) Dowsett M, Smith I, Ebbs S, Dixon J, Skene A, A’Hern R, et al. Prognostic value of Ki67 expression after short-term presurgical endocrince therapy for primary breast cancer. J Natl Cancer Inst (2007) 99:167–70.
(2) Retsky M, Demicheli R, Hrushesky WJM. Wounding from biopsy and breast cancer progression. Lancet (2001) 357:1048.[ISI][Medline]
(3) Demicheli R, Bonadonna G, Hrusheksy W, Retsky MW, Valagussa P. Menopausal status dependence of the timing of breast cancer recurrence after surgical removal of the primary tumor. Breast Cancer Res Treat (2004) 6:R689–96.
(4) Retsky M, Demicheli R, Hrusheksy WJM. Does surgery induce angiogenesis in breast cancer? Indirect evidence from relapse pattern and mammography paradox. Int J Surg (2005) 3:179–87.[CrossRef][Medline]
(5) Badwe R, Fentiman I, Saad Z, Bentley A, Richards M, Gregory W, et al. Surgical procedures, menstrual cycle phase, and prognosis in operable breast cancer [letter]. Lancet (1991) 338:815–6.[CrossRef][ISI][Medline]
(6) Baum M, Demicheli R, Hrusheksy W, Retsky MW. Does surgery unfavorably perturb the "natural history" of early breast cancer by accelerating the appearance of distant metastases? Eur J Cancer (2005) 41:508–15.[CrossRef][ISI][Medline]
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J Natl Cancer Inst 2007 99: 167-170.
J Natl Cancer Inst 2007 99: 1053-1054.
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