title: Role of Ki67 in predicting resistance to adjuvant tamoxifen in postmenopausal breast cancer patients.
abstract: BACKGROUND
  Breast cancer (BC) is a major health problem in Egypt and worldwide. Its prognosis depends not only on tumor stage but also on tumor biology.
  
  
  OBJECTIVE
  To correlate the expression of Ki67 with the clinical outcomes of early hormone-receptor positive postmenopausal BC patients who are receiving tamoxifen.
  
  
  METHODS
  This cohort study included 70 patients. They were followed up for a minimum of 2 years. Ki67 was assessed on paraffin-embedded blocks using immunohistochemistry methods.
  
  
  RESULTS
  The median Ki67 value was 22.5% (IQR, 10%-50%). Ki67 was significantly higher in patients with HER2 positive tumors compared to HER2 negative tumors. After a median follow up period of 53 months, 22 patients (31%) developed disease recurrence either loco-regional or distant in 5.7% and 30%, respectively. Recurrent patients had significantly higher tumor stage, nodal stage and Ki67 values compared to non-recurrent cases. The 2-, 3- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 100% & 91%, 98% & 84% and 77% & 59%, respectively. DFS was significantly worse with higher TNM stage, lower ER expression and higher Ki67 values. OS was significantly worse in patients with Ki67 values ≥ 30%. Ki67 ≥ 30% was an independent predictor of recurrence, poor DFS and OS.
  
  
  CONCLUSIONS
  High Ki67 expression is predictive of poor prognosis and of resistance to adjuvant tamoxifen therapy in postmenopausal BC. We recommend considering Ki67 as one of the risk factors that guide adjuvant treatment decisions.
authors.affiliation: Department of Medical Oncology/Hematology, National Cancer Institute, Cairo University, Egypt.
authors.forename: Heba M
authors.initials: HM
authors.lastname: Elzawahry
authors.forename: Magdy M
authors.initials: MM
authors.lastname: Saber
authors.forename: Nadia M
authors.initials: NM
authors.lastname: Mokhtar
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Zeeneldin
authors.forename: Yahia M
authors.initials: YM
authors.lastname: Ismail
authors.forename: Nelly H
authors.initials: NH
authors.lastname: Alieldin
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D019008:Drug Resistance, Neoplasm / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000235:genetics / Q000378:metabolism*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017698:Postmenopause; D011446:Prospective Studies; D012008:Recurrence; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D019394:Ki-67 Antigen; D013629:Tamoxifen
keywords: Adjuvant hormonal therapy; Breast cancer; Egypt; Ki67; National Cancer Institute; Postmenopausal; Tamoxifen