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Clinical factors such as tumor size and nodal status do not impact on response to NeoET but do relate to the overall prognosis of patients. Their interaction with competing factors of advanced age/frailty and co-morbidity is helpful for decision-making in individual patients, and assists clinicians in prioritising the individual for surgery within a larger cohort of patients competing for appropriate care as in the COVID-19 pandemic. Thus, while the clinician should take these features into account when making decisions on appropriateness of NeoET the complexity of the interactive factors precludes our making precise recommendations. The preoperative endocrine prognostic index (PEPI) was derived from patients in clinical trials where the length of NeoET varied between 12 and 18 weeks (12 weeks IMPACT/P024 and 16–18 weeks for Z1031 7 ). If a longer or shorter period of NeoET is used, the PEPI approach could still be applied on an individual basis, since the Ki67 is prognostic after very short periods of time (2 to 4 weeks). 75618, cerca de 1,7 do resultado da aposta esportiva seninha tabela arrecadação bruta dos concursos de prognósticos e da loteria federal vão para o COB. Genomic assays are in widespread use for the selection of those patients with ER+ HER2− node-negative breast cancer who should receive adjuvant chemotherapy as well as endocrine therapy. They estimate risk of distant recurrence on endocrine therapy alone largely by integrating information on baseline proliferation and features relating to the likelihood of endocrine responsiveness. Their main objective is to aid in counselling patients regarding their individual risk/benefit ratio for the use of chemotherapy. In contrast to the data presented here, there are no data on the relationship of genomic assays and local control with NeoET. Our proposal also has the advantage of undertaking an on-treatment measurement of the response to endocrine therapy (2–4 week Ki67). If a genomic assay is undertaken it must be conducted on a biopsy before starting NeoET since this has a profound but so far ill-described effect on the expression of many genes in the tests.
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