J Breast Cancer.  2013 Dec;16(4):395-403. 10.4048/jbc.2013.16.4.395.

Expression of Immunohistochemical Markers before and after Neoadjuvant Chemotherapy in Breast Carcinoma, and Their Use as Predictors of Response

Affiliations
  • 1Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 2Department of Pathology, Konyang University College of Medicine, Daejeon, Korea.
  • 3Department of Pathology, Korea Cancer Center, Seoul, Korea.
  • 4Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 6Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. iapark@snu.ac.kr

Abstract

PURPOSE
For patients with breast carcinoma, immunohistochemical markers are important factors in determining the breast cancer subtype and for establishing a therapeutic plan, including the use of neoadjuvant chemotherapy (NACT). However, it is not clear whether the expression of certain markers changes after NACT.
METHODS
We assessed estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, p53, and Bcl-2 expression in specimens from 345 breast cancer cases before and after NACT. We analyzed the association between response to NACT and the expression of the markers in pre-NACT specimens. We also compared the expression between pre- and post-NACT specimens.
RESULTS
ER and PR expression was negatively associated with pathological complete response (pCR). HER2 was associated with pCR in all cases, but the association was lost when the cases were subdivided according to hormone receptor status. The pre-NACT tumor size of cases with pCR after NACT was smaller than that of cases with residual disease. HER2-enriched and triple-negative breast cancers were more likely to achieve pCR than luminal A type cancers. PR expression and the Ki-67 index decreased after NACT. A decrease in the Ki-67 index was also demonstrated in hormone receptor positive and HER2-enriched subtypes, but no similar tendency was observed in the triple-negative subtype.
CONCLUSION
A patient with breast cancer scheduled for NACT should be assessed for the breast cancer subtype, as this will influence the treatment plans for the patient. The expression of PR and Ki-67 after NACT should be interpreted carefully because NACT tends to reduce the expression of these molecules.

Keyword

Breast neoplasms; Drug therapy; Immunohistochemistry; Ki-67 antigen; Progesterone receptors

MeSH Terms

Breast Neoplasms
Breast*
Drug Therapy*
Estrogens
Humans
Immunohistochemistry
Ki-67 Antigen
Phenobarbital
Polymerase Chain Reaction
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Estrogens
Ki-67 Antigen
Phenobarbital
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

  • Figure 1 Immunohistochemical stains for progesterone receptor (PR) (A, B) and Ki-67 (C, D) before (A, C) and after (B, D) neoadjuvant chemotherapy (NACT) (×200). PR is positive in the biopsy specimen before NACT (A) and negative in the resection specimen after NACT (B). The Ki-67 index of the tumor is about 70% in the biopsy specimen before NACT (C), while it is significantly decreased in the resection specimen after NACT (D).


Cited by  1 articles

HER2 status in breast cancer: changes in guidelines and complicating factors for interpretation
Soomin Ahn, Ji Won Woo, Kyoungyul Lee, So Yeon Park
J Pathol Transl Med. 2020;54(1):34-44.    doi: 10.4132/jptm.2019.11.03.


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