Ki-67 Expression is a Significant Prognostic Factor Only When Progesterone Receptor Expression is Low in Estrogen Receptor-Positive and HER2-Negative Early Breast Cancer

Kang, Young-Joon; Lee, Han‐Byoel; Kim, Yun Gyoung; Han, Jaihong; Kim, Yumi; Yoo, Tae-Kyung; Lee, Eun-Shin; Moon, Hyeong‐Gon; Noh, Dong‐Young; Han, Wonshik

doi:10.1155/2019/7386734

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…When the critical value of Ki-67 index was 10%, for both high expression (≥10%) and low expression (<10%), patients with BC show statistical differences in OS and recurrence-free survival (RFS) when there's low PR expression (<20%). In particular, patients with high Ki-67 expression and low PR expression had the poorest prognosis [20]. Similarly, Ki-67 index is signi cant to DFS judgment of patients with BC.…”

Section: Discussionmentioning

confidence: 89%

Prognostic and Molecular Classification Value of Ki-67 Index in Patients With Breast Cancer

Wang¹,

Tian³

et al. 2020

Preprint

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Background: The Ki-67, which is a proliferative index, became more important in making treatment decisions of breast cancers. But a few factors limited its use in clinical practices, especially the assessment of positive cells percentage of Ki-67 and the cut-off value of Ki-67. In this study, we examined the expression of Ki-67 by immunohistochemical method, and evaluated the value of Ki-67 index in patients with breast cancers systematically.Methods: The expression of Ki-67 was detected by immunohistochemical method, the relationship between over-survive (OS), disease free survive (DFS) of patients with BCs and Ki-67 index，and the value of Ki-67 in molecular classification of BC were analyzed with SPSS ver. 18.0 and GraphPad Prism software.Results: There were markedly difference between OS in patients with BC when the Ki-67 index arranged from 46% to 68% (χ2 = 6.87, P = 0.0088; χ2 = 7.69, P = 0.0056 respectively), and the same results were also found when the positive density was added to the Ki-67 index, but the positive density has limited value in assessment the value of Ki-67. There were markedly difference between DFS in BCs when the Ki-67 index arranged from 50% to 58% (χ2 = 7.31, P = 0.0068; χ2 = 7.88, P = 0.005). When using 14% as a cut-off point to classify the molecular type of BC, the Luminal A-type patients had statistical differences with patients with HER-2 over-expression, with triple negative type BC in term of OS respectively (χ2 = 4.8, P = 0.028; χ2 = 3.89, P = 0.049). There’s statistical difference between OS of patients with HER-2 over-expression BC when the Ki-67 index fell in the range of 49%- 60% (χ2 =4.97, P = 0.0259; χ2 =5.61, P = 0.0178, respectively). There were statistical differences between the Luminal A-type BC and HER-2 over-expression BC in term of OS (χ2 = 4.65, P = 0.031) according to suggestions of the CSCO consensus in 2019, there were statistical differences between two groups of Luminal B HER-2 (-) type BCs when the Ki-67 index was 52% (χ2=6.61, P = 0.0101).Conclusions: Ki-67 index can be used to assess the OS and DFS of patients with BC, and the positive density of Ki-67 has little value in assessment of prognosis in patients with BC. Different molecular classification methods may influence the assessment of prognosis and the results of molecular type in patients with BC.

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Section: Discussionmentioning

confidence: 89%

Prognostic and Molecular Classification Value of Ki-67 Index in Patients With Breast Cancer

Wang¹,

Tian³

et al. 2020

Preprint

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“…Ki-67 is an antigen associated with cell proliferation and generally less than 10% with benign tumors, but more than 10% with malignant tumors. In patients with invasive breast cancer, the higher Ki-67 expression, the faster the proliferation of cancer cells, and the greater the likelihood of metastasis (19)(20)(21)(22). As the Ki-67 level increases, cell growth increases, so the tumor cell density is higher, resulting in a decrease of the apparent diffusion coefficient.…”

Section: Discussionmentioning

confidence: 99%

Correlation between apparent diffusion coefficient and pathological characteristics of patients with invasive breast cancer

Chen¹,

Wang²,

Zhang³

et al. 2021

Ann Transl Med

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Background: There is insufficient research on the correlation between the apparent diffusion coefficient and clinicopathological characteristics of breast cancer patients. The present study is to investigate the correlation between the apparent diffusion coefficient and pathological characteristics of patients with invasive breast cancer.Methods: From January 2019 to September 2020, 122 cases of invasive breast cancer and 21 cases of benign tumors were retrospectively enrolled. The apparent diffusion coefficient was compared between the two groups, and the correlation between the apparent diffusion coefficient and the pathological characteristics of the patients with invasive breast cancer were analyzed.Results: Compared with the benign tumor group, the apparent diffusion coefficient in the invasive breast cancer group was significantly lower (0.89±0.17 vs. 1.47±0.27 10 −3 mm 2 /s, P=0.000). Using the apparent diffusion coefficient to diagnose patients with invasive breast cancer, the area under receiver operating characteristic (ROC) curve was 0.966±0.021 [95% confidence interval (CI): 0.924-1.000, P=0.000], and the best diagnostic cut-off value was 1.16 (10 −3 mm 2 /s), with sensitivity and specificity of 0.905 and 0.902, respectively. The apparent diffusion coefficient was used to diagnose vascular tumor thrombus in patients with invasive breast cancer. The area under the ROC curve was 0.641±0.068 (95% CI: 0.508-0.774, P=0.047), and the best diagnostic threshold was 0.835 (10 −3 mm 2 /s), with sensitivity and specificity of 0.676 and 0.650, respectively. The apparent diffusion coefficient in patients with high expression of Ki-67 (%) was significantly reduced (0.87±0.17 vs. 1.00±0.16 10 −3 mm 2 /s, P=0.000). The apparent diffusion coefficient was not significantly correlated with age, menopause, lesion size, estrogen receptor, progesterone receptor, or lymph node metastasis in patients with invasive breast cancer (P>0.05). Conclusions:In patients with invasive breast cancer the apparent diffusion coefficient was significantly reduced. It was able to differentiate invasive breast cancer and vascular tumor thrombus, and was also related to Ki-67 (%) high expression.

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“…Criscitiello et al investigated 1241 patients with Luminal B early stage breast cancer with 1-3 axillary positive nodes and found that patients with high Ki67 expression (>32%) could bene t from adjuvant chemotherapy in addition to HT [34]. Kang et al reported that patients with high Ki67 expression had poorer RFS and OS compared with those with low Ki67 expression (10% of cutoff) only when the PR was low [35]. Unfortunately, we did not test the cohort at this Ki67 level.…”

Section: Discussionmentioning

confidence: 99%

Omission of Chemotherapy in HR+/HER2− Early Invasive Breast Cancer Based on Combined 6-IHC Score?

Lin

Guo

Wang

et al. 2021

Clinical Breast Cancer

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Background: Previous randomized studies have assessed the possibility of omission of chemotherapy in some hormone receptor (HR)-positive and HER2-negative (HR+/HER2-) breast cancers (BC) based on gene pro ling test, e.g., Oncotype DX. The goal of this study was to evaluate if combination of six proliferation related biomarkers by immunohistochemistry (6-IHC) could be a cost-effective option in determining the necessity of adjuvant chemotherapy in HR+/HER2-BC.Methods: A retrospective analysis of HR+/HER2-BC patients was conducted in the First A liated Hospital of China Medical University from 2010 to 2016. The expression of 6 BC-related proliferation and invasion genes (Cathepsin L2, MMP11, CyclinB1, Aurora A, Survivin and Ki67) from Oncotype DX were analyzed through IHC (designated as 6-IHC). All the included patients were divided randomly at a 7:3 ratio into training and testing cohorts. The cutoff prognosis index (PI) of 6-IHC was determined by multivariate Cox risk regression analysis after calculating the PI of each patient in training cohort and con rmed in testing cohort. The patients were classi ed into "Low" and "High" risk groups based on the PI value.Kaplan-Meier (KM) method was used to analyze Disease-free survival (DFS) and overall survival (OS). 6-IHC score and other factors associated with survival bene t of adjuvant chemotherapy were compared with Ki67 index.Results: A total of 330 patients were included and divided into training cohort (n = 231) and validation cohort (n = 99). The receiver operating characteristic (ROC) curve analysis showed that the patients can be divided into 6-IHC score "High" and "Low" risk groups using the cut-off PI of 2.16. The 8-year DFS and OS were 54.6% and 69.2%, respectively in the 6-IHC score "High" risk group; 85.5% and 92.5%, respectively in the 6-IHC score "Low" risk group. The 8-year DFS and OS were 70.8% and 80.9%, respectively in the Ki67 "High" risk group, 77.7% and 87.6%, respectively in the Ki67 "Low" risk group. The KM curves showed that chemotherapy did not signi cantly improve the DFS in the 6-IHC score "Low" risk group (p = 0.830), but signi cantly improved the DFS in the 6-IHC score "High" risk group (P = 0.012).Conclusions: Combined 6-IHC score could be a reliable tool in predicting cancer-speci c recurrences and survival in HR+/HER2-BC patients and identifying patients who could bene t from adjuvant chemotherapy regardless of the involvement of axillary lymph node (ALN).

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Ki-67 Expression is a Significant Prognostic Factor Only When Progesterone Receptor Expression is Low in Estrogen Receptor-Positive and HER2-Negative Early Breast Cancer

Cited by 12 publications

References 28 publications

Prognostic and Molecular Classification Value of Ki-67 Index in Patients With Breast Cancer

Prognostic and Molecular Classification Value of Ki-67 Index in Patients With Breast Cancer

Correlation between apparent diffusion coefficient and pathological characteristics of patients with invasive breast cancer

Omission of Chemotherapy in HR+/HER2− Early Invasive Breast Cancer Based on Combined 6-IHC Score?

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