Expression of Survivin and HER-2 as Independent Predictive Factors for Treatment Response in Locally Advanced Breast Cancer: A Prospective Cohort Study

Abstract

BACKGROUND: Locally advanced breast cancer (LABC) requires a multimodal approach, often starting with neoadjuvant chemotherapy (NACT) to reduce tumor size. However, response to NACT in LABC is highly variable. Predictive biomarkers such as HER-2 and Survivin may have the potential to predict treatment response and prognosis. This study aims to analyze the relationship between Survivin and HER-2 expression and the clinical response to NACT in LABC patients. METHODS: In this prospective cohort study, we enrolled 56 female LABC patients scheduled for a Taxane, Adriamycin, and Cyclophosphamide NACT regimen. Pre-treatment biopsy tissues were examined for Survivin and HER-2 expression via immunohistochemistry. Clinical response was evaluated after three cycles using the RECIST criteria. Data were analyzed using the Chi-Square test and multivariate logistic regression. RESULTS: High Survivin expression was found in 32/56 (57.1%) participants and positive HER-2 expression in 28/56 (50%). A significant correlation was found between high Survivin expression and HER-2 positivity (p=0.007). High Survivin expression (p<0.001; PR=4.688; 95% CI: 1.881-11.682) and HER-2 positivity (p<0.001; PR=5.585; 95% CI: 2.227-14.012) were significantly associated with poor chemotherapy response (non-response). Multivariate analysis showed that Survivin (OR=0.032; p=0.002) and HER-2 (OR=0.022; p=0.001) were significant independent predictors of chemotherapy response. CONCLUSION: Survivin and HER-2 expression are significantly associated and serve as independent predictors of poor response to NACT in LABC patients. Evaluation of these biomarkers could be crucial in risk stratification and the personalization of therapy.

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