Effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese breast cancer patients: A retrospective study of 525 patients

Abstract

This study was designed to investigate the effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese female breast cancer patients. The expression of estrogen receptor (ER), progesterone receptor (PR) and Ki67 among 525 neoadjuvant chemotherapy cases was studied by immunohistochemistry. Differences between specimens made through preoperative core needle biopsy and excised tissue biopsy were observed. The positive rates of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy were 65.3% and 63.2%, 51.0% and 42.6%, 65.6% and 43.4%, respectively. The expression of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy had no statistically significant difference. However, after neoadjuvant chemotherapy, the discordance rates of ER, PR and Ki67 were 15.2% (79/521), 26.9% (140/520) and 44.8% (225/502), respectively. The ER, PR and Ki67 status changed from positive to negative in 7.5% (39/521), 13.3% (69/520) and 21.1% (106/502) of the patients, whereas ER, PR and Ki67 status changed from negative to positive in 7.7% (40/521), 13.6% (71/520) and 23.7% (119/502) of the patients, respectively. These results showed that the status of some biomarkers changes after neoadjuvant chemotherapy and biomarker status needs to be reexamined to optimize adjuvant systemic therapy and better prognosis assessment.

Keywords

breast cancer / neoadjuvant chemotherapy / hormone receptors / Ki67

References

[1] Torre LA, Bray F, Siegel RL, Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87–108

[2] Bonadonna G, Valagussa P, Brambilla C, Preoperative chemotherapy in operable breast cancer[J]. Lancet, 1993, 341(8858): 1485

[3] Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis[J]. J Natl Cancer Inst, 2005, 97(3): 188–194

[4] Kaufmann M, von Minckwitz G, Bear HD, Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006[J]. Ann Oncol, 2007, 18(12):1927–1934.

[5] van de Velde CJ, Rea D, Seynaeve C, Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial[J]. Lancet, 2011, 377(9762): 321–331

[6] Burstein HJ, Prestrud AJ, Anderson H, American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer[J]. J Clin Oncol, 2010, 32(21): 2255–2269

[7] Davies C, Godwin J, Gray R, Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials[J]. Lancet, 2011, 378(9793): 771–784

[8] van de Ven S, Smit VT, Dekker TJ, Discordances in ER, PR and HER2 receptors after neoadjuvant chemotherapy in breast cancer[J]. Cancer Treat Rev, 2011, 37(6): 422–430

[9] Arens N, Bleyl U, Hildenbrand R. HER2/neu, p53, Ki67, and hormone receptors do not change during neoadjuvant chemotherapy in breast cancer[J]. Virchows Arch, 2005, 446(5): 489–496

[10] Tacca O, Penault-Llorca F, Abrial C, Changes in and prognostic value of hormone receptor status in a series of operable breast cancer patients treated with neoadjuvant chemotherapy[J]. Oncologist, 2007, 12(6): 636–643

[11] Fasching PA, Heusinger K, Haeberle L, Ki67, chemotherapy response, and prognosis in breast cancer patients receiving neoadjuvant treatment[J]. BMC Cancer, 2011, 11: 486

[12] Cheang MC, Chia SK, Voduc D, Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer[J]. J Natl Cancer Inst, 2009, 101(10): 736–750

[13] Kasami M, Uematsu T, Honda M, Comparison of estrogen receptor, progesterone receptor and Her-2 status in breast cancer pre- and post-neoadjuvant chemotherapy[J]. Breast, 2008, 17(5): 523–527

[14] Adams AL, Eltoum I, Krontiras H, The effect of neoadjuvant chemotherapy on histologic grade, hormone receptor status, and HER2/neu status in breast carcinoma[J]. Breast J, 2008, 14(2): 141–146

[15] Huang J, Ji G, Xing L, Neo-endocrinochemotherapy: a novel approach for enhancing chemotherapeutic efficacy in clinic[J]? Med Hypotheses, 2013, 80(4): 441–446

[16] Kitagawa D, Saji S, Horiguchi S, Alternation of estrogen receptor and progesterone receptor expression in primary breast cancer patients treated with neoadjuvant chemotherapy[J]. Breast J, 2010, 16(4): 435–436

[17] Hirata T, Shimizu C, Yonemori K, Change in the hormone receptor status following administration of neoadjuvant chemotherapy and its impact on the long-term outcome in patients with primary breast cancer[J]. Br J Cancer, 2009, 101(9): 1529–1536

[18] von Minckwitz G, Schmitt WD, Loibl S, Ki67 measured after neoadjuvant chemotherapy for primary breast cancer[J]. Clin Cancer Res, 2013, 19(16): 4521–4531

[19] Yoshioka T, Hosoda M, Yamamoto M, Prognostic significance of pathologic complete response and Ki67 expression after neoadjuvant chemotherapy in breast cancer[J]. Breast Cancer, 2015, 22(2): 185–191

[20] Tan QX, Qin QH, Yang WP, Prognostic value of Ki67 expression in HR-negative breast cancer before and after neoadjuvant chemotherapy[J]. Int J Clin Exp Pathol, 2014, 7(10): 6862–6870

[21] Goldhirsch A, Wood WC, Coates AS, Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011[J]. Ann Oncol, 2011, 22(8): 1736–1747

[22] Goldhirsch A, Winer EP, Coates AS, Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol, 2013, 24(9): 2206–2223

[23] Wang J, Sang D, Xu B, Value of breast cancer molecular subtypes and Ki67 expression for the prediction of efficacy and prognosis of neoadjuvant chemotherapy in a Chinese population[J]. Medicine (Baltimore), 2016, 95(18): e3518.

Acknowledgments

This study was supported by National Natural Science Foundation of China (NSFC) (81372851) and through provision of data by the Breast Cancer Center of Chongqing, Chongqing Medical University, China. The opinions, results and conclusions reported in this article are those of the authors.

Contribution statement

Ling-quan Kong conceptualised and designed the study, interpreted the data and drafted the manuscript. Yutuan Wu, Xin Li, Linjie Lu, Lu Gan, Wei Dai and Yanling Shi, Vishnu Prasad Adhikari contributed to the study design, drafted the manuscript, acquired and analysed the data. Kainan Wu contributed to the study design and interpretation of data and critically revised the manuscript. All authors approved the final version of the paper to be published.

RIGHTS & PERMISSIONS

2018 2018 by the Journal of Biomedical Research.