International Journal of Hematology and Oncology
2024, Vol 34, Num 3 Page(s): 123-130
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Predictive Roles of Ki 67 level & mPEPI Score for Neoadjuvant ‘Chemotherapy’ Efficacy in Locally Advanced ER(+)/HER2(-) Breast Cancer
Mutlu DOGAN1, Cengiz KARACIN1, Omur KAMAN1, Zarife Melda BULUT2, Gamze KIZILTAN3, Berna OKSUZOGLU1, Lutfi DOGAN3
1University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology
2University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Pathology
3University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of General Surgery & Surgical Oncology
Neoadjuvant chemotherapy (NAC) & modified preoperative endocrine prognostic index (mPEPI) score after NAC role is unclear in locally advanced ER+/HER2(-) breast cancer (LA-HnLBC). We aimed to evaluate prognostic & predictive factors including mPEPI score for NAC in LA-HnLBC, retrospectively. 142 LA-HnLBC patients were classified as pCR( n:26) & non-pCR (n: 116) & categorized for PR/ki67/ki67 decline/mPEPI score patients were included. Median age was 53 years. pCR rate was 18.3%. Median ER/PR/ki67 were as 90%/40%/40%. Median basal & postoperative ki67 level was 40. pCR group had more T2(73%), grade 3 (69%) & non-pCR had more T3(21%), grade 2(46%) tumors (p= 0.03,p= 0.03). pCR group had lower mPEPI score (3.5 vs 5,p= 0.05). 5y-DFS was 69% (pCR 93.8%,non-pCR 63.4%, p= 0.012). 5y-OS was 77% (pCR 100%,non-pCR 72%, p= 0.018).In univariate analysis, high basal/postoperative ki67 levels, ki67 decline & mPEPI score were significant poor prognostic factors for DFS (p= 0.01, p< 0.001, p= 0.017, p< 0.001) & OS (p= 0.006, p= 0.003, p= 0.05, p= 0.001) in non-pCR goup. Prognostic cut-offs were as 40 for basal ki67 (DFS & OS), 20 for postoperative ki67 (DFS), 4 for mPEPI (DFS) & 30 for ki67 decline (OS). Favorable prognostic factors were defined as lower basal ki67 level (< 40%) & higher ki67 decline (ki67 <30%) for OS; lower basal ki67 (<40%), po ki 67 (< 20%) & mPEPI score (< 4) for DFS after NAC in LA HnLBC. Different prognostic cut-offs for basal & postoperative ki 67 is striking. mPEPI score may also have prognostic significance after NAC in LA-HnLBC patients.
Mutlu DOGAN1, Cengiz KARACIN1, Omur KAMAN1, Zarife Melda BULUT2, Gamze KIZILTAN3, Berna OKSUZOGLU1, Lutfi DOGAN3
1University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology
2University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Pathology
3University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of General Surgery & Surgical Oncology
Neoadjuvant chemotherapy (NAC) & modified preoperative endocrine prognostic index (mPEPI) score after NAC role is unclear in locally advanced ER+/HER2(-) breast cancer (LA-HnLBC). We aimed to evaluate prognostic & predictive factors including mPEPI score for NAC in LA-HnLBC, retrospectively. 142 LA-HnLBC patients were classified as pCR( n:26) & non-pCR (n: 116) & categorized for PR/ki67/ki67 decline/mPEPI score patients were included. Median age was 53 years. pCR rate was 18.3%. Median ER/PR/ki67 were as 90%/40%/40%. Median basal & postoperative ki67 level was 40. pCR group had more T2(73%), grade 3 (69%) & non-pCR had more T3(21%), grade 2(46%) tumors (p= 0.03,p= 0.03). pCR group had lower mPEPI score (3.5 vs 5,p= 0.05). 5y-DFS was 69% (pCR 93.8%,non-pCR 63.4%, p= 0.012). 5y-OS was 77% (pCR 100%,non-pCR 72%, p= 0.018).In univariate analysis, high basal/postoperative ki67 levels, ki67 decline & mPEPI score were significant poor prognostic factors for DFS (p= 0.01, p< 0.001, p= 0.017, p< 0.001) & OS (p= 0.006, p= 0.003, p= 0.05, p= 0.001) in non-pCR goup. Prognostic cut-offs were as 40 for basal ki67 (DFS & OS), 20 for postoperative ki67 (DFS), 4 for mPEPI (DFS) & 30 for ki67 decline (OS). Favorable prognostic factors were defined as lower basal ki67 level (< 40%) & higher ki67 decline (ki67 <30%) for OS; lower basal ki67 (<40%), po ki 67 (< 20%) & mPEPI score (< 4) for DFS after NAC in LA HnLBC. Different prognostic cut-offs for basal & postoperative ki 67 is striking. mPEPI score may also have prognostic significance after NAC in LA-HnLBC patients.
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