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Expression of immunohistochemical markers in locally advanced breast carcinoma and their use as predictors of pathological response.

Indu Arun, Sonali Nayak,  Animesh Saha, Paromita Roy, Divya Midha, Pradeep Kumar, Rosina Ahmed, Sanjoy Chatterjee

Tata Medical Centre, Kolkata, India

Objectives: Immunohistochemical assessment of Ki67 is being used empirically in addition to more established biomarkers like ER, PgR and Her-2 for treatment planning in patients with breast cancer. We analysed the prognostic and predictive value of Ki67 alone and in combination with other prognostic markers in achieving pathological complete response.

Methods: The association of  Ki 67 index with ER/PR/HER2NEU and other histopathological parameters and response to neoadjuvant chemotherapy (NACT) including pathological complete response (pCR) was determined between possible molecular subtypes of breast cancer.

Results: Overall 25.3.% had pCR,  27.4%  of which had Grade 3 tumours compared to 16.9% with grade 1/ 2. pCR rates based on luminal A (LA), luminal B (LB), HER2-enriched (HE), and triple-negative (TN) subtypes were 13.6%,24.4, 26.3 and 33.3% respectively. Those with Ki-67( < 14%) had pCR rate of  17.14% compared to 23.07% in Ki- 67( ≥ 14%) group. Significant changes in ER and Ki-67 expression occurred post NACT.

Conclusion: Patients with LA subtype breast cancer had a poorer response to NACT , while no significant difference existed in pCR rates amongst Her 2 rich and Luminal B cases . NACT reduced transcription of ER receptor and also caused steep reduction in Ki67 index.

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