ArticleThe Lancet regional health. Europe2025
Prognostic significance of tumour Ki-67 dynamics during neoadjuvant treatment in patients with breast cancer: a population-based cohort study.
Article in The Lancet regional health. Europe, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Lack of Utility of Ki-67 in Axillary Surgical Planning and Prognostication after Neoadjuvant Chemotherapy for Node-Positive Breast Cancer.Annals of surgical oncology · 2026Article
- AGO Breast Panel Recommendations for the use of treatment-relevant biomarkers in early and advanced breast cancer-2026 Update.Breast (Edinburgh, Scotland) · 2026Review
- The logarithmic phase as a therapeutic direction: evaluating pharmacological strategies against cancer progression.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Review
- Pathological Complete Response After Neoadjuvant Chemotherapy in Breast Cancer: A Literature Overview.Cancers · 2026Review
- AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2026.Breast care (Basel, Switzerland) · 2026Review
- Article
- A radiomics-deep learning nomogram integrating intratumoral and peritumoral DCE-MRI features for pCR prediction in breast cancer.Frontiers in oncology · 2026Article
- Predicting dynamic changes of Ki-67 in breast cancer after neoadjuvant therapy based on multi-phase DCE-MRI delta-radiomics.Frontiers in oncology · 2026Article
- Hollow CuInternational journal of nanomedicine · 2026Article
- Utility of Ki-67 index combined with alpha-fetoprotein and lactate dehydrogenase in distinguishing mature from immature ovarian teratomas in children.Frontiers in neurologyArticle
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Authors and funding
16 authors.
Funding
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Abstract
Background: Although Ki-67 is a commonly used proliferation marker in breast cancer (BC), its prognostic value after neoadjuvant chemotherapy (NACT) remains unclear. This study aims to investigate the prognostic implications of Ki-67 dynamics during NACT. Methods: Patients with invasive BC treated with NACT (2007-2020) were identified through the National Breast Cancer Register (NBCR). Associations between Ki-67 dynamics with survival outcomes were studied (spline-based Cox regression). The prognostic value of Ki-67 in the Neo-Bioscore model was examined and optimal cut-off values for relative change of Ki-67 ((post-NACT-pre-NACT Ki-67)/pre-NACT Ki-67) were explored (minimum p-value approach). Findings: Among 2494 patients, median pre-NACT Ki-67 was 40% (IQR:28-65%). Median post-NACT Ki-67 in patients with residual disease (n = 1826) was 12% (IQR:5-35%). Lower post-NACT Ki-67 was associated with better breast cancer specific survival (BCSS) in the whole cohort (p < 0.0001), in ER+/HER2- (p = 0.0001) and TNBC (p = 0.0007), but not in HER2+ BC (p = 0.8223). Post-NACT Ki-67 improved the Neo-Bioscore prognostic model increasing the C-index from 0.758 to 0.802. Post-NACT Ki-67, as well as absolute and relative change of Ki-67 were strongly correlated with each other and were prognostic for long-term outcomes. Optimal cut-off values for relative change of Ki-67 identified prognostic subgroups for ER+/HER2- BC (n = 730, p < 0.0001), and TNBC (n = 279, p < 0.0001). The results were validated in an external TNBC cohort of 221 patients (p = 0.00073). Notably, the identified low-risk patients with residual disease and at least 48% reduction of Ki-67 after NACT, had comparable survival to those with pathological complete response (pCR) (p = 0.13). Interpretation: Relative change of Ki-67 was independently prognostic for patient risk stratification. Ki-67 in residual disease warrants for further investigation when exploring post-neoadjuvant treatment strategies. Funding: Cancerfonden, Vetenskapsrådet, Cancerföreningen i Stockholm and Region Stockholm.
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