The transcription factor KLF4 as an independent predictive marker for pathologic complete remission in breast cancer neoadjuvant chemotherapy: a case–control study

Abstract

Min Jun Dong,1 Lin Bo Wang,1 Zhi Nong Jiang,2 Mei Jin,2 Wen Xian Hu,1 Jian Guo Shen1 1Department of Surgical Oncology, 2Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China Background: To identify whether a stem cell biomarker, KLF4, may predict the pathologic tumor response to neoadjuvant chemotherapy for patients with locally advanced breast cancer. Methods: Twelve locally advanced breast cancer patients who achieved pathologic complete remission (pCR) after neoadjuvant chemotherapy were identified and for each, three non-pCR breast cancer patients – matched for age, clinical tumor–node–metastasis stage, and neoadjuvant chemotherapy cycles – were selected. The relationship between KLF4 expression in the core needle biopsied cancer tissue and patient pCR rate was assessed using univariate and multivariate analysis. Results: Receiver operating characteristic curve analysis showed that the patients with a histoscore of KLF4 expression >0.18 had a lower pCR rate. Multivariable analysis showed that higher KLF4 expression (odds ratio 0.013; 95% confidence interval 0.013–0.444; P=0.004) was independently correlated with a lower pCR rate after neoadjuvant chemotherapy. Conclusion: KLF4 overexpression was associated with lower pCR in locally advanced breast cancer patients undergoing neoadjuvant chemotherapy. This study suggests that KLF4 may serve as a predictor for pCR in patients with breast cancer after neoadjuvant chemotherapy. Keywords: locally advanced breast cancer, predictor, stem cell biomarker, pathologic tumor response