Integration of Ki-67 index into AJCC 2018 staging provides additional prognostic information in breast tumours candidate for genomic profiling

Abstract

BACKGROUND: The Eighth edition of the American Joint Committee on Cancer (AJCC) staging system (2018) for breast cancer (BC) introduced the prognostic stage. Moreover, multigene assessment has been indicated to tailor staging in T1/T2/N0, ER-positive/ HER2-negative BC. However, many National Health Systems do not provide reimbursement for routine testing. The aim of this study was to assess whether Ki67 proliferation index is prognostically relevant for patients' candidacy for molecular testing. METHODS: A retrospective series of 686 ER+/HER2− BC were reclassified using AJCC 2018, and in the group of 521 patients for which AJCC 2018 recommends molecular evaluation, we assessed the prognostic efficacy of a prognostic stage enriched by Ki67 (Ki67-PS), considering Ki67 <20% an alternative to recurrence score <11 provided by Oncotype DX. RESULTS: We found that a group of BCs (35.6%, 58/163) assigned to IB stage by prognostic score were down classified to IA with Ki67-PS. The outcome of these 58 cases overlapped with that of lesions classified as stage IA using prognostic stage, showing a significantly better prognosis compared to IB tumours (HR = 2.79, p = 0.003). CONCLUSIONS: These data suggest that Ki67 may be a reliable marker to enrich the 2018 AJCC prognostic score in BC patients' candidacy for genomic profiling.

Predictability of 21-Gene Recurrence Score Assay by Using Pathological and Immunohistochemical Parameters in Breast Cancer

“…This finding is contrary to the findings earlier reported where stage 1 was found to be associated with a more favorable clinical outcome compared with stages 2 and 3. 32 This discrepancy could be because of the selection bias leading to only 3.5% of stage 3 cases in our study population.…”

The long non coding RNA H19 as a biomarker for breast cancer diagnosis in Lebanese women

“…MCF-7/AdrVp breast cancer cells multi-resistant to several treatments showed a more abundant expression of H19 compared to parental MCF-7 cells 41 . Moreover, the degree of differentiation correlated to Ki 67 42 , hormone receptors, but also cell types, can explain, while overlapping, the different levels of H19′s expression. H19 has been reported to be associated with differentiation of luminal progenitor cells from estrogen-regulated cells 11 , 43 .…”

Concomitant use of 18F-FDG PET-CT SUVmax is useful in the assessment of Ki67 labeling index in core-needle biopsy specimens of breast cancer

“…However, none of these molecular tests is reimbursed by the national health insurance system in many European countries and Japan. Hence, the attempts to use Ki67LI as partly substitute information obtained by molecular profiling have been reported, since most of the genes evaluated by these molecular profiling assays are related to cell proliferation (28). From this point of view, we think that it is significant to utilize Ki67LI together with the information obtained from diagnostic imaging.…”