Clinical-pathologic characteristics and response to neoadjuvant chemotherapy in triple-negative low Ki-67 proliferation (TNLP) breast cancers Journal Article

   

Authors:	Srivastava, P.; Wang, T.; Clark, B. Z.; Yu, J.; Fine, J. L.; Villatoro, T. M.; Carter, G. J.; Brufsky, A. M.; Gorantla, V. C.; Huggins-Puhalla, S. L.; Emens, L. A.; Basili, T.; da Silva, E. M.; Reis-Filho, J. S.; Bhargava, R.
Article Title:	Clinical-pathologic characteristics and response to neoadjuvant chemotherapy in triple-negative low Ki-67 proliferation (TNLP) breast cancers
Abstract:	Triple-negative breast cancers (TNBCs) often have a high Ki-67 proliferation index and respond favorably to neoadjuvant chemotherapy (NACT) with pathologic complete response (pCR) resulting in ~40% of cases. Nevertheless, morbidity/mortality remain high, mostly due to recurrence in patients with residual disease. In contrast, the incidence and clinical features of TNBC with low proliferation (TNLP), defined as TNBC with a Ki-67 index of ≤30% remains unknown. We report 70 cases of TNLP identified at our center from 2008 to 2018, including 18 treated with NACT. TNLP tumors represent <1% of all breast cancers, and ~5–10% of TNBCs. Ninety percent of carcinomas were grade I/II and 70% were either pure apocrine or showed apocrine differentiation. Fifty cases had available immunohistochemistry results; 80%, 84%, 22%, and 20% were positive for AR, INPP4B, nestin, and SOX10, respectively. With a median follow-up of 72 months, 14% experienced recurrence, and 11% died of breast cancer. The tumor stage was prognostic. Among 39 stage-I patients, 18 (46%) received chemotherapy, but this did not impact survival. There was a trend for improved recurrence-free survival with chemotherapy in stage-II patients. Of the 18 patients treated with NACT, 2 (11%) showed pCR; these were notable for either high stromal TILs or a high mitotic count despite a low Ki-67 index. TNLPs are enriched in low to intermediate-grade carcinomas with apocrine features. Due to overall good prognosis of stage-I TNLP and the lack of clear benefit of chemotherapy, de-escalation of chemotherapy may be considered in select patients with stage-I TNLP. © 2022, The Author(s).
Journal Title:	npj Breast Cancer
Volume:	8
ISSN:	2374-4677
Publisher:	Nature Publishing Group
Date Published:	2022-04-20
Start Page:	51
Language:	English
DOI:	10.1038/s41523-022-00415-z
PROVIDER:	scopus
PMCID:	PMC9021249
PUBMED:	35444182
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85128481354&doi=10.1038%2fs41523-022-00415-z&partnerID=40&md5=f80d76d6abfe737af40906d953c07cc2
Notes:	Article -- Export Date: 2 May 2022 -- Source: Scopus

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