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Introducción El cáncer de mama es una enfermedad heterogénea; tumores con factores pronósticos similares presentan diferente evolución, lo que hace suponer que la diferencia es molecular. El antígeno de proliferación celular Ki67 es un factor clave que representa la actividad mitótica celular. Objetivos Analizar el subtipo Luminal B y el valor del Ki67, evaluando su relación con los factores pronósticos y predictivos clásicos, y determinar su utilidad para subclasificar grupos moleculares en función del mismo. Material y métodos Estudio descriptivo, retrospectivo, analítico observacional. Se revisaron 520 fichas de patología mamaria pertenecientes al Hospital Churruca y al Sanatorio Corporación Médica General San Martín, en el período comprendido entre enero 2010-enero 2015. Fueron analizadas 82 pacientes subtipo Luminal B, con Ki67 elevado. Resultados La mediana de expresión del Ki67 fue de 25,9% y del 34% en las pacientes recaídas. Discusión Se observó relación proporcional del Ki67 con el tamaño tumoral y el grado histológico. Conclusiones El Ki67 debe ser analizado en la práctica diaria por patólogos expertos, a fin de predecir el comportamiento frente a tratamientos adyuvantes de una manera más certera, adecuando la terapéutica a cada paciente.
Introduction Breast cancer is a heterogeneous disease; tumors with similar prognostic factors have different evolution, which suggests that the difference is at the molecular level. The proliferation antigen Ki67 is a key factor that represents the cell mitotic activity. Objectives Analyze Luminal B subtype and the value of Ki67, evaluating its relationship with prognostic and predictive factors conventionally used. Determine its usefulness for subclassified different molecular groups. Matherials and method Observational analytical retrospective study. We reviewed 520 breast cancer files belonging to Churruca Hospital and Sanatorio Corporación Médica General San Martín in the period between January 2010- January 2015. We analyzed 82 patients Luminal B subtype with hight Ki67. Results The median expression of Ki67 was 25.9 % and 34% in patients with relapsed. Discussion We found proportional relationship between the value of Ki67 with tumor size and histologic hight grade. Conclusions The Ki67 must be analyzed in daily practice validated by expert pathologists in late predict behavior towards adjuvant treatments in a more accurate way available, adapting to each patient therapeutic methods.
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Humans , Female , Breast Neoplasms , Phenobarbital , PrognosisABSTRACT
Objective: To investigate the differences in the curative effects of neoadjuvant chemotherapy (NAC) for different subtypes of Luminal B breast cancer and its prognosis, and to discuss the clinical treatment characteristics of different subgroups. Methods: A total of 246 cases of Luminal B like breast cancer patients who completed the projected NAC courses and surgical treatment were selected. All the biopsy specimens before treatment were positive for estrogen receptot (ER). According to the expressions of progesterone receptor (PR), human epidermal growth factor-2 (Her-2) and cell proliferation nuclear antigen Ki-67, 246 cases of Luminal B breast cancer patients were divided into 3 subgroups. A subgroup (PR low expression group), Her-2 negative and PR0.05). There were significant differences in the lymph node metastasis rate among three subgroups (P=0.018), and the lymph node metastasis rate was the highest in A subgroup among three subgroups. There were no significant differences in the clinical response and pathological response among three subgroups (P= 0.123, P=0.06). 8.5% 21/246) patients achieved the pathological complete response (pCR); the rates of pCR in three subgroups had statistically significant difference (P=0.009); the rate of pCR in C subgroup was the highest, and the rate of pCR in B subgroup was the lowest. The Log-Rank test of the survival curves of three subgroups had not statistically significant difference (P=0.216), but the 3-year disease-free survival (DFS) and 5-year DFS of the patients in B subgroup were slightly higher than those in other two groups. The DFS of the patients in C subgroup was longer than that of the patients with Her-2 overexpression breast cancer at the same period, and the difference was statistically significant (P= 0.047). Conclusion: Her-2 positive Luminal B breast cancer is more likely to achieve pCR in NAC and the prognosis is better than Her-2 overexpressing breast cancer. The patients with high expression of PR in Luminal B breast cancer patients have a tend of overall survival advantage compared with the patients with PR low expression and Her-2 positive expression.
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Objective:To investigate the differences in the curative effects of neoadjuvant chemotherapy(NAC) for different subtypes of Luminal B breast cancer and its prognosis,and to discuss the clinical treatment characteristics of different subgroups.Methods:A total of 246 cases of Luminal B like breast cancer patients who completed the projected NAC courses and surgical treatment were selected.All the biopsy specimens before treatment were positive for estrogen receptot(ER).According to the expressions of progesterone receptor(PR), human epidermal growth factor-2(Her-2)and cell proliferation nuclear antigen Ki-67,246 cases of Luminal B breast cancer patients were divided into 3 subgroups.A subgroup(PR low expression group),Her-2 negative and PR< 20% or negative,Ki-67 any levels;B subgroup(PR high expression group),Her-2 negative,PR≥20% and Ki-67 ≥14%;C subgroup(Her-2 positive group),Her-2 positive,Ki-67 and PR any levels.The clinical pathological materials and follow-up recurrence events of the patients were collected.Results:Among the three subtypes of Luminal B breast cancer,there were no significant differences in the age,the size of primary tumor and the stage of TNM(P>0.05).There were significant differences in the lymph node metastasis rate among three subgroups(P=0.018),and the lymph node metastasis rate was the highest in A subgroup among three subgroups. There were no significant differences in the clinical response and pathological response among three subgroups(P=0.123,P=0.06).8.5%(21/246)patients achieved the pathological complete response(pCR);the rates of pCR in three subgroups had statistically significant difference(P=0.009);the rate of pCR in C subgroup was the highest, and the rate of pCR in B subgroup was the lowest.The Log-Rank test of the survival curves of three subgroups had not statistically significant difference(P=0.216),but the 3-year disease-free survival(DFS)and 5-year DFS of the patients in B subgroup were slightly higher than those in other two groups.The DFS of the patients in C subgroup was longer than that of the patients with Her-2 overexpression breast cancer at the same period,and the difference was statistically significant(P=0.047).Conclusion:Her-2 positive Luminal B breast cancer is more likely to achieve pCR in NAC and the prognosis is better than Her-2 overexpressing breast cancer.The patients with high expression of PR in Luminal B breast cancer patients have a tend of overall survival advantage compared with the patients with PR low expression and Her-2 positive expression.
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Objective To assess the prognostic value of progesterone receptor (PR) in Luminal B HER2(-) lymph-node-negative breast cancer.Methods The clinical data of 196 Luminal B HER2 (-) lymph-node-negative breast cancer patients were collected in this study.The correlation between PR and clinicopathological factors and its influence on prognosis was analyzed.Results Among 196 patients with Luminal B HER2 (-) lymph-node-negative breast cancer,14.8％(29/196)were PR-negative and 85.2％(167/196)were PR-positive (HR=3.25,95.0％ CI:0.73-1.45,P=0.123).PR negativity indicated postmenopausal status (P=0.029) and high tumor grade (P=0.001).Mter a median follow-up of 60 months,9.7％(19/196) of the patients had relapses and 4.1％(8/196) died of breast cancer.The 5-year disease-free survival(DFS) was 75.9％ in PR-negative group and 92.8％ in PR-positive group (Log-rank P=0.001).The 5-year overall survival (OS) was 89.7％ in PR-negative group and 97.0％ in PR-positive group (Log-rank P=0.023).In multivariate analysis,PR negativity was significantly associated with a poor 5-year DFS (HR=2.85,95.0％ CI:1.05-7.72,P=0.039)but not with 5-year OS (HR=1.78,95.0％ CI:0.34-9.35,P=0.495).Conclusion In this study,PR is a prognostic factor for relapse in Luminal B HER (-) lymph-node-negative breast cancer.
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Breast cancer can be classiifed into 4 intrinsic subtypes by gene expression proifling: basal-like, HER-2-positive, Luminal A and Luminal B. Although Luminal cancers share similarities, the studies showed that Lu-minal A and B breast cancers should be perceived as distinct entities. Luminal B breast cancer has lower expression of hormone receptors, and it also exhibits worse prognosis and has a distinct proifle of response to chemotherapy and en-docrine therapy. This review presented the available clinical evidence for chemotherapy and endocrine therapy patterns of response, and potential targets for treatment.
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Luminal B breast cancer is a main subtype of breast cancer.Disease free survival and overall survival rate of patients with Luminal B subtype are lower than those of patients with Luminal A subtype.Luminal B breast cancer is often treated with chemotherapy and endocrine therapy,and anti-Her-2 therapy is also essential for Luminal B/Her-2 positive breast cancer,but the prognosis is still poor.With the increasing understanding of Luminal B breast cancer,new targets are developed and used for improving treatment effect.This review will describe the clinical and pathological features,factors affecting prognostic,common treatments and new therapeutic targets for Luminal B breast cancer.
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Objective:To investigate the clinical, pathological, and prognostic characteristics of luminal B breast cancer patients with diabetes. Methods:A total of 479 luminal B breast cancer patients with diabetes and 3 392 luminal B breast cancer patients without diabetes who were treated between January 2002 and December 2006 were enrolled in this study. The luminal B breast cancer patients were further divided into the luminal B (high ki67) and luminal B (Her-2/neu+) subgroups. Each subgroup was further grouped into metformin-treated, non-metformin-treated, and non-diabetic groups. The indicators included cancer-specific mortality, clinical, pathological stage, lymph node status, chemotherapy, and endocrine therapy. The survival analysis of each group was performed using the Kaplan-Meier method, and the significance was determined using the logrank test. Cox proportional hazard model was used to examine the correlation between each factor and the prognosis. Results:The Kaplan-Meier analysis results revealed that the breast cancer mortality rates in the metformin-treated, non-metformin-treated, and non-diabetic groups were significantly different in both luminal B (high ki67) and luminal B (Her-2/neu+) subgroups (logrank test:P<0.001, P=0.035), and the respective five-year survival rates were 93.5%, 81%, and 89%for the luminal B (high ki67) subgroup and 84%, 77%, and 83%for the luminal B (Her-2/neu+) subgroup. The Cox multifactorial regression analysis results showed that compared with the metformin-treated group, the non-metformin-treated group was associated with a significantly increased risk of mortality (P<0.001, P=0.044) in the two subgroups. Meanwhile, the non-diabetic group was associated with an increased risk of mortality (P=0.038) in the luminal B (high ki67) subgroup only. The percentage of elderly (P<0.001), menopausal (P<0.001), obese (P<0.001), and patients with cardio-cerebrovascular complications (P<0.001) tended to be higher in the metformin-treated and non-metformin-treated groups than in the diabetic group. Moreover, the metformin-and non-metformin-treated groups in the luminal B (high ki67) subgroup were associated with high percentages of T3/4 pathological stage (P<0.001), lymph node metastasis (P=0.001). The non-metformin-treated group was associated with a lower percentage of invasive ductal carcinoma (P=0.001) compared with the other two groups. Conclusion:The non-metformin-treated group resulted in worse clinical outcomes in both subgroups compared with the metformin-treated group. Meanwhile, the non-diabetic group resulted in the worst prognosis among the three groups in the luminal B (high ki67) subgroup. These findings suggest that the choice of different anti-diabetic drugs may influence the prognosis of luminal B breast cancer patients with diabetes.