Ki-67 index after neoadjuvant endocrine therapy as a prognostic biomarker in patients with ER-positive/HER2-negative early breast cancer: a systematic review and meta-analysis
- Author(s)
- Martins-Branco, D; Nader-Marta, G; Molinelli, C; Ameye, L; Paesmans, M; Ignatiadis, M; Aftimos, P; Salgado, R; de Azambuja, E;
- Journal Title
- European Journal of Cancer
- Publication Type
- Research article
- Abstract
- BACKGROUND: Neoadjuvant treatment discriminates responders, but pathologic complete response is uncommon in oestrogen receptor (ER)-positive/HER2-negative early breast cancer. We aimed to assess the prognostic value of Ki-67 index after neoadjuvant endocrine therapy (NET). METHODS: We conducted a systematic literature search of PubMed, Embase, CENTRAL, and conference proceedings up to 22nd August 2023 to identify studies reporting the association of Ki-67 index after NET with recurrence-free survival (RFS) and/or overall survival (OS) in women with ER-positive/HER2-negative early breast cancer. We combined RFS and OS hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Twelve studies including 7897 patients were analysed. Most studies were clinical trials (n = 7547) including only postmenopausal women (n = 3953) treated with aromatase inhibitor (n = 3359). Three studies evaluated Ki-67 in a preplanned core biopsy at 2-4 weeks of NET (n = 3348), while nine evaluated Ki-67 in the surgical specimen (n = 4549) after 2-24 weeks of NET. Median follow-up ranged between 37 and 95 months for RFS and 62-84 months for OS. High Ki-67 index after NET was significantly associated with worse RFS (HR 2.48, 95% CI 1.86-3.30) and OS (HR 2.66, 95% CI 1.65-4.28). A sensitivity analysis including three studies that measured Ki-67 in a preplanned core biopsy showed similar association with RFS (HR 2.41, 95% CI 1.77-3.30). CONCLUSIONS: High Ki-67 after NET is associated with worse survival outcomes, even after a short course of NET, emphasising the prognostic value of this biomarker in women with ER-positive/HER2-negative early breast cancer.
- Keywords
- Humans; Female; *Breast Neoplasms/pathology; Neoadjuvant Therapy; Ki-67 Antigen; Prognosis; Receptor, ErbB-2; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Anastrazole; Breast neoplasms; Fulvestrant; Oestrogen antagonists; Preoperative period; Proliferative index; Selective oestrogen receptor modulators; Tamoxifen
- Department(s)
- Laboratory Research
- PubMed ID
- 37857118
- Publisher's Version
- https://doi.org/10.1016/j.ejca.2023.113358
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-08-20 06:17:34
Last Modified: 2024-08-20 06:56:39