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Abstract
Introduction. Clinical calculators and short-term hormone sensitivity testing are the most accessible tools for personalizing adjuvant therapy in luminal breast cancer (BC) patients.
Aim. To evaluate the prognosis of the disease using preoperative hormone response test and to identify factors associated with improved prognosis according to the PREDICT prognostic model in patients with luminal HER2-negative BC.
Materials and Methods. The study included 254 patients with luminal HER2-negative BC. All patients underwent short-term preoperative hormone sensitivity testing. Based on menopausal status, patients received tamoxifen (n = 78), tamoxifen with ovarian suppression (n = 17), or aromatase inhibitors (n = 159). Following surgery, tumor proliferative activity was assessed on surgical specimens by evaluating changes in tumor grade, Ki67 levels, and hormone receptor expression. The PREDICT prognostic model was used to calculate 10-year overall survival separately for biopsy and surgical specimens.
Results. After hormone sensitivity testing, 10-year overall survival rates calculated by PREDICT were significantly higher (p < 0.0001) both for adjuvant hormone therapy (HT) alone and for combined hormone therapy and chemotherapy (HT+CT). The survival rate increased by an average of 2.5 % in the HT group and by 2.1 % in the HT+CT group. No significant difference in survival gain was observed between the groups (p = 0.22). Only changes in Ki67 expression, estrogen receptor expression, and tumor grade significantly improved the 10-year survival rates calculated by PREDICT. Each percentage point decrease in Ki67 level was associated with a 0.089 % increase in survival (p < 0.001). A one-grade reduction in tumor grade was associated with a 2.34 % improvement in prognosis (p = 0.012).
Conclusion. The Ki67 biomarker plays a leading role in predicting survival using the PREDICT prognostic model. Reduction in proliferative activity during preoperative hormone sensitivity testing is primarily associated with increased overall survival.
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