Impact of combining the progesterone receptor and preoperative endocrine prognostic index (PEPI) as a prognostic factor after neoadjuvant endocrine therapy using aromatase inhibitors in postmenopausal ER positive and HER2 negative breast cancer

<div><p>The preoperative endocrine prognostic index (PEPI) predicts survival after neoadjuvant endocrine therapy (NAE) using aromatase inhibitors (AIs) for women with postmenopausal estrogen receptor (ER)-positive breast cancer irrespective of the human epidermal growth factor receptor 2 (HER2) status. Although the progesterone receptor (PgR) is also a prognostic factor for ER-positive breast cancer, the PgR status was not considered a prognostic factor in the original PEPI scoring system. In this study, we investigated the utility of a modified PEPI including the PgR status (PEPI-P) as a prognostic factor after NAE for postmenopausal patients with ER-positive and HER2-negative breast cancer. We enrolled 107 patients with invasive ER-positive and HER2-negative breast cancer treated with exemestane for ≥4 months as NAE. We initially assessed PEPI and compared survival between the groups. Additionally, we obtained an effective cutoff for PgR through survival analysis. Then, we assessed the survival significance of PEPI-P. A PgR staining rate of 50% was the most significant cutoff for predicting recurrence-free survival (RFS) and cancer-specific survival (CSS). PEPI was a significant prognostic factor; moreover, PEPI-P was the most significant prognostic indicator for RFS and CSS. PEPI-P is a potent prognostic indicator of survival after NAE using AIs for postmenopausal patients with ER-positive and HER2-negative breast cancer. This modified PEPI may be useful for therapeutic decision-making regarding postmenopausal ER-positive and HER2-negative breast cancer after NAE.</p></div

Cumulative survival of patients with breast cancer stratified by the original preoperative endocrine prognostic index (PEPI).

<p>(A) Recurrence-free survival (RFS) was significantly worse in the high PEPI group than in the low PEPI group (<i>P</i> = 0.013). (B) No significant differences were noted in cancer-specific survival (CSS) between the high and low PEPI groups (<i>P</i> = 0.092).</p

Survival analysis of the influence of clinicopathological variables including the preoperative endocrine prognostic index (PEPI) and PEPI combined with the primary PgR status (PEPI-P).

<p>Survival analysis of the influence of clinicopathological variables including the preoperative endocrine prognostic index (PEPI) and PEPI combined with the primary PgR status (PEPI-P).</p

Cumulative survival of patients with breast cancer stratified by our modified PEPI including the primary PgR status (PEPI-P).

<p>Relationships of PEPI-P with (A) recurrence-free (RFS) and (B) cancer-specific survival (CSS).</p

Survival analysis according to the Allred score and PgR staining percentage in primary tumors.

<p>Survival analysis according to the Allred score and PgR staining percentage in primary tumors.</p

Recurrence-free survival (RFS) and cancer-specific survival (CSS) curves for the high (≥50%) and low primary progesterone receptor (p-PgR) (<50%) groups.

<p>RFS and CSS were significantly better in the high p-PgR group than in the low p-PgR group (RFS: <i>P</i> = 0.0053; CSS: <i>P</i> = 0.0031).</p

Washing effectiveness of the gauze and device.

<p>A. Representative images of the endoscopic view after repeated cleaning of the contaminated lens after gauze wiping. B. Representative images of the endoscopic view after repeated cleaning of the contaminated lens according to the number of device cleaning. C. Luminescence evaluation of residual contaminants on the lens after cleaning according to the number of cleaning by gauze and the device.</p

Our device had better cleaning ability than that of gauze wiping.

<p>A. Representative endoscopic views: the upper panel shows the image after cleaning the contaminated lens with gauze, and the lower panel shows the contaminated lens after cleaning with the device. B. Luminescence evaluation of residual contaminants on the lens after cleaning by gauze and by the device.</p

Mechanism and structure of our novel lens cleaning device.

<p>A. Appearance. B. Manipulation techniques for lens cleaning started by covering the air hole with a finger. C. Schema of the device. The left panel shows that the air runs through the device without covering the hole with a finger, the middle panel shows the water cleaning initiated by air-hole covering with finger and scope, and the right panel shows that water drops on the lens surface after cleaning are removed by air aspiration through the air hole.</p

Accumulation of contaminants on the lens surface after repeated cleaning.

<p>Three wipes with gauze or one cleaning pass by using our device were performed repeatedly.</p