RESUMO
Association of estrogen receptor (ER), progesterone receptor (PR), HER2, Ki67 and 70-gene classifier (70-GC) with a response to paclitaxel (PAC) (n=79) or docetaxel (DOC) (n=55) was investigated in the neoadjuvant setting for breast cancer patients. Sensitivity of breast tumors to PAC, but not to DOC, was found to be significantly associated with ER negativity (P=0.003), PR negativity (P=0.007), and Ki67 positivity (P=0.007). Breast tumors classified into the responders by 70-GC showed a significantly (P=0.005) higher reduction rate to PAC and interestingly a significantly (P=0.009) lower reduction rate to DOC than those classified into the non-responders by 70-GC, suggesting that 70-GC might be useful for the differentiation of PAC-sensitive and DOC-sensitive breast tumors.
Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Paclitaxel/uso terapêutico , Taxoides/uso terapêutico , Neoplasias da Mama/classificação , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Docetaxel , Feminino , Perfilação da Expressão Gênica , Humanos , Antígeno Ki-67/análise , Receptor ErbB-2/análise , Receptores de Estrogênio/análise , Receptores de Progesterona/análiseRESUMO
PURPOSE: Recently, Ki67 index (cell proliferation marker) has been attracting a considerable attention as a prognostic factor in breast cancer but the prognostic significance of Ki67 after neoadjuvant chemotherapy (NAC) has rarely been examined. EXPERIMENTAL DESIGN: Primary breast cancer patients (n = 102) treated with NAC (sequential paclitaxel 12 cycles (q1w) and 5-FU/epirubicin/cyclophosphamide 4 cycles (q3w)) were recruited in the study. Ki67, estrogen receptor (ER) and progesterone receptor (PR) and breast cancer resistant protein (BCRP) and P-glycoprotein were determined by immunohistochemistry and HER2 was determined by FISH in tumor tissues obtained before and after NAC, and their association with patient prognosis (relapse-free survival) was examined. RESULTS: Of the 102 patients, pCR was achieved in 30 (29.4%). In the 72 non-pCR patients, Ki67 index significantly (P < 0.001) decreased after NAC. Ki67 index after NAC, but not Ki67 index before NAC, was significantly associated with a patient prognosis (P = 0.022). Multivariate analysis has shown that Ki67 index after NAC is a marginally significant (P = 0.05) prognostic factor and that other biomarkers including ER, PR, BCRP, and P-glycoprotein before and after NAC are not significant. CONCLUSIONS: Ki67 after NAC, but not before NAC, is prognostic in breast cancer patients, and might be clinically useful in the prognosis prediction of patients who do not achieve pCR after NAC. On the other hand, BCRP and P-glycoprotein before and after NAC are unlikely to be useful as prognostic factors in these patients.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Antígeno Ki-67/genética , Adulto , Intervalo Livre de Doença , Feminino , Marcadores Genéticos , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , PrognósticoRESUMO
SUMMARY: In the 150 endovascular performed cases from May 1997 to Dec 2004, supplemental combination of endovascular and surgical treatments were performed in 46 cases. Characteristics of the treatments were combination for multiple aneurysms, surgical clipping for failed endovascular attempt, embolization for recurrence after clipping, bypass surgery before endovascular parent artery occlusion, surgery for recurrent aneurysms after embolization, and embolization for failed surgical attempt. Sixty seven percent of ruptured and 87% of unruptured cases showed satisfactory clinical outcome (modified Rankin scale = 0 to 2). Supplemental combination of each treatment will support the disadvantage of another treatment, and which improve the clinical outcome of cerebral aneurysm.