RESUMEN
PURPOSE: The prognostic value of Ki-67 in triple-negative breast cancer (TNBC) is yet unclear because the cut-off points employed differ widely and its predictive effect may vary according to age. The purpose of this study was to analyze the role of Ki-67 among patients with TNBC, and determine the optimal Ki-67 cut-off point to demonstrate its prognostic relevance associated with patient age and treatment strategy. METHODS/PATIENTS: 201 consecutive patients treated for primary TNBC from 1999 to 2014 were analyzed. Clinicopathological characteristics and outcomes were compared between patients treated with neoadjuvant or adjuvant chemotherapy. We used time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) to evaluate the discriminative ability of Ki-67 at 3 and 5 years of follow-up. A Ki-67 cut-off point that maximized sensibility and specificity was established. Interaction effect between age and Ki-67 on disease-free survival (DFS) and overall survival (OS) was evaluated by stratified analysis. RESULTS: According to the coordinates of the ROC curves, the best cut-off point for Ki-67 was 60% (high/low). In the whole group, there was not a statistically significant association between Ki-67 and OS and DFS, using a cut-off point of 60%. In multivariate analysis (COX proportional hazards regression), for DFS high Ki-67 (> 60%) was a poor prognostic factor in patients > 40 years old and a better prognostic factor among the patients < 40 years old. CONCLUSION: Prognostic value of Ki-67 in TNBC, using a cut-off point of 60%, may vary depending on age.
Asunto(s)
Envejecimiento/fisiología , Biomarcadores de Tumor/metabolismo , Antígeno Ki-67/metabolismo , Neoplasias de la Mama Triple Negativas/diagnóstico , Neoplasias de la Mama Triple Negativas/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/metabolismo , Biomarcadores de Tumor/análisis , Quimioterapia Adyuvante/estadística & datos numéricos , Terapia Combinada/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Antígeno Ki-67/análisis , Mastectomía/estadística & datos numéricos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Análisis de Supervivencia , Neoplasias de la Mama Triple Negativas/metabolismo , Neoplasias de la Mama Triple Negativas/terapiaRESUMEN
En la literatura se tiene conocimiento de multiples casos de hepatopatia secundaria a la ingestion de alfametildopa, la lesion varia entre elevacion transitoria de aminotransferasas hasta hepatitis fulminante y muerte del enfermo. Al revisar la literatura al alcance se obtuvo informacion de 198 pacientes con esta complicacion. Se presentan los casos de tres pacientes con lesion hepatica en quienes la unica causa de la misma fue la ingestion de alfametildopa. Aun no se conoce exactamente cual es el mecanismo patogenico del farmaco, pero por la evolucion de los pacientes y la revision de la literatura se proponen los dos siguientes: 1. Alteraciones inmunologicas en el huesped. 2. Probable produccion de factores inmunogenos por la incorporacion del farmaco o sus metabolitos a la membrana celular del hepatocito