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© The Author 2007. Published by Oxford University Press.
BRIEF COMMUNICATION |
Prognostic Value of Ki67 Expression After Short-Term Presurgical Endocrine Therapy for Primary Breast Cancer
On behalf of the IMPACT Trialists Group
Affiliations of authors: Academic Department of Biochemistry (MD, RA, JS, SD, MH) and Department of Medicine—Breast Unit (IES, GW), The Royal Marsden Hospital, London, U.K.; Department of Surgery, Mayday University Hospital, Croydon, U.K. (SRE); Edinburgh Breast Unit, Western General Hospital, Edinburgh, U.K. (JMD); Department of Surgery, Royal Bournemouth, Hospital, Dorset, U.K. (AS)
Correspondence to: Mitch Dowsett, PhD, Academic Department of Biochemistry, 4th Floor, Wallace Wing, The Royal Marsden Hospital, Fulham Road, London SW3 6 JJ, U.K. (e-mail: mitch.dowsett{at}icr.ac.uk).
Tumor expression of the proliferation antigen Ki67 is widely used to assess the prognosis of cancer patients. A change in the expression of Ki67 after short-term exposure of patients to therapeutic agents is frequently used as a pharmacodynamic marker of efficacy, particularly among breast cancer patients before undergoing surgery. To determine the clinical significance of the level of tumor cell proliferation during endocrine therapy for breast cancer, we measured the expression of Ki67 in tumor biopsy samples taken before and after 2 weeks of presurgical treatment with anastrozole or tamoxifen or the combination of anastrozole plus tamoxifen in 158 patients with hormone receptor–positive primary disease. In a multivariable analysis, we found that higher Ki67 expression after 2 weeks of endocrine therapy was statistically significantly associated with lower recurrence-free survival (P = .004) whereas higher Ki67 expression at baseline was not. Larger baseline tumor size and lower estrogen receptor level after 2 weeks of treatment were also statistically significantly associated with poorer recurrence-free survival (P<.001 and P = .04, respectively). Our data indicate that measurements of tumor Ki67 level after short-term endocrine treatment may improve the prediction of recurrence-free survival by integrating the prognostic value of Ki67 level at baseline with changes in Ki67 level that are associated with treatment benefit.
| CONTEXT AND CAVEATS Prior knowledge Tumor expression of the cell proliferation antigen Ki67 is widely used to select the best treatment for and to predict the prognosis of breast cancer patients. However, it is not known if tumor Ki67 expression after short-term endocrine therapy can predict recurrence-free survival of individual patients or if it is a more accurate predictor of recurrence-free survival than measurements of tumor Ki67 before treatment. Study design Ki67 levels in breast tumor biopsy samples taken before and after 2 weeks of presurgical endocrine treatment were evaluated as predictors of recurrence-free survival in postmenopausal primary breast cancer patients enrolled in the IMPACT trial. Contributions Higher tumor Ki67 expression predicted worse recurrence-free survival better after 2 weeks of adjuvant therapy than before adjuvant therapy. Implications Measurements of tumor Ki67 expression after short-term endocrine treatment may improve the prediction of recurrence-free survival for breast cancer patients. Limitations The conclusions were based on a small number of patients. Larger studies are needed to confirm the results.
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- Response: Re: Prognostic Value of Ki67 Expression After Short-Term Presurgical Endocrine Therapy for Primary Breast Cancer
- Mitch Dowsett and Ian E. Smith
J Natl Cancer Inst 2007 99: 1053-1054.[Extract] [Full Text] [PDF]
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