Ki-67 index after neoadjuvant endocrine therapy as a prognostic biomarker in patients with ER-positive/HER2-negative early breast cancer: a systematic review and meta-analysis

Differences in risk factors for mortality between T2N1M0 and T3N0M0 lobular breast cancer patients: a comparative study

Objective

This study aimed to explore the differences in risk factors for mortality between T2N1M0 and T3N0M0 lobular breast cancer, and investigate the factors associated with non-lobular breast cancer mortality.

Methods

Data from 2,693 T2N1M0 and 1,384 T3N0M0 lobular breast cancer patients from the SEER database (2008-2018) were analyzed. The lobular breast cancer-specific and non-lobular breast cancer mortality were compared using the Kaplan-Meier curve and Log-rank test. The Cox proportional hazards regression analysis was used to determine the risk factors associated with non-lobular breast cancer mortality.

Results

The total survival time showed a significant difference between the T2N1M0 and T3N0M0 groups (p = 0.0011). Statistically significant difference were found in lung-related disease mortality (p = 0.0023), with the survival rate of T2N1M0 higher than that of T3N0M0. Age, surgery, radiotherapy, and chemotherapy were independent factors associated with mortality in lung-related disease patients with both subtypes, and compared with T2N1M0, radiotherapy in T3N0M0 increased the risk of lung-related disease mortality (HR = 2.076, 95% CI: 1.4318-3.011).

Conclusion

The T3N0M0 group had a higher mortality rate from lung-related diseases compared to the T2N1M0 group, and radiotherapy may increase the risk of lung-related disease death in T3N0M0 patients. These findings provide valuable information for treatment strategies for T2N1M0 and T3N0M0 subtypes of patients and assist physicians and patients make better treatment choices.

Ki67 Tumor Expression Predicts Treatment Benefit Achieved by Macroscopic Radical Lung-Preserving Surgery in Pleural Mesothelioma-A Retrospective Multicenter Analysis

Pleural mesothelioma (PM), linked to asbestos-induced inflammation, carries a poor prognosis. Therapy ranges from therapy limitation to aggressive multimodality treatment. Given the uncertainty about treatment benefits for patients, this study aimed to assess the role of Ki67 as a prognostic and predictive parameter in PM. Ki67 was measured in the specimens of 70 PM patients (17 female, 53 male) from two centers and correlated to overall survival (OS) and therapy outcome. The median OS was 16.1 months. The level of Ki67 expression was divided into low (≤15%) and high (>15%). A low value of Ki67 expression was associated with a longer OS (Ki67 ≤ 15%: 31.2 (95% CI 6.5-55.8) months vs. Ki67 > 15%: 11.1 (95% CI 7.7-14.6) months, p = 0.012). The 5-year survival represents 22% in the low Ki67 expression group, in contrast to 5% in the high Ki67 expression group. We found a significant interaction term of Ki67 with multimodality treatment (p = 0.031) translating to an OS of 48.1 months in the low expression Ki67 group compared to 24.3 months in the high Ki67 expression group when receiving surgery within multimodality therapy. Therefore, Ki67 stands out as a validated prognostic and, most importantly, novel predictive biomarker for treatment benefits, particularly regarding surgery within multimodality therapy.

Case report: Primary CDK4/6 inhibitor and endocrine therapy in locally advanced breast cancer and its effect on gut and intratumoral microbiota

Locally advanced breast cancer poses significant challenges to the multidisciplinary team, in particular with hormone receptor (HR) positive, HER2-negative tumors that classically yield lower pathological complete responses with chemotherapy. The increasingly significant use of CDK 4/6 inhibitors (CDK4/6i) plus endocrine therapy (ET) in different breast cancer settings has led to clinical trials focusing on this strategy as a primary treatment, with promising results. The impact of the microbiota on cancer, and vice-versa, is an emerging topic in oncology. The authors report a clinical case of a postmenopausal female patient with an invasive breast carcinoma of the right breast, Luminal B-like, staged as cT4cN3M0 (IIIB). Since the lesion was considered primarily inoperable, the patient started letrozole and ribociclib. Following 6 months of systemic therapy, the clinical response was significant, and surgery with curative intent was performed. The final staging was ypT3ypN2aM0, R1, and the patient started adjuvant letrozole and radiotherapy. This case provides important insights on primary CDK4/6i plus ET in locally advanced unresectable HR+/HER2- breast cancer and its potential implications in disease management further ahead. The patient's gut microbiota was analyzed throughout the disease course and therapeutic approach, evidencing a shift in gut microbial dominance from Firmicutes to Bacteroidetes and a loss of microbial diversity following 6 months of systemic therapy. The analysis of the intratumoral microbiota from the surgical specimen revealed high microbial dissimilarity between the residual tumor and respective margins.