Ki 67 is a major, but not the sole determinant of Oncotype Dx recurrence score

Sahebjam, Solmaz; Aloyz, Raquel; Pilavdzic, Dragana; Brisson, M.; Ferrario, Cristiano; Bouganim, Nathaniel; Cohen, Victor; Miller, Wilson H.; Panasci, Lawrence C.

doi:10.1038/bjc.2011.402

Cited by 77 publications

(72 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Routine testing of breast cancers for Ki-67 expression is not currently recommended by either the American Society of Clinical Oncology or the National Comprehensive Cancer Network. 42,43 Our data support other studies [22][23][24]26,27 which suggest that Ki-67 is critical in the assessment of risk stratification for patients with ER-positive breast cancer patients who are being considered for systemic chemotherapy.…”

Section: Modern Pathology (2015) 28 921-931supporting

confidence: 80%

“…The risk categories used by the Oncotype DX recurrence score (low (o 18), intermediate (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), or high (430)) were applied to the modified Magee recurrence score, and the modified Magee recurrence scores were compared with their paired Oncotype DX recurrence scores for correlation (Pearson correlation) and concordance. We compared the average modified Magee recurrence score, ER, PR, and Ki-67 values at several cutoff points to determine how they stratified into the high and low Oncotype DX recurrence score risk stratification groups.…”

Section: Discussionmentioning

confidence: 99%

“…14 Oncotype DX uses quantitative reverse transcription-polymerase chain reaction and an algorithm to calculate a recurrence score, giving the highest weight to proliferation (which includes Ki-67), followed by HER-2, ER, and PR. The Oncotype DX recurrence score is reported as a number that is divided into either low (o 18), intermediate (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), or high (430) recurrence risk categories.…”

mentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22][23][24][25][26][27] Four of the 16 genes (ER, PR, HER-2, and Ki-67) measured as parts of the Oncotype DX panel are routinely assessed at the protein level by immunohistochemistry 28 in the routine diagnostic evaluation of breast cancer. Four linear regression analysis equations (Magee equations) have been published 15,16 using several histopathologic variables, and semiquantitative results from these four immunophenotypic markers (ER, PR, HER-2, and Ki-67).…”

mentioning

confidence: 99%

See 3 more Smart Citations

Use of modified Magee equations and histologic criteria to predict the Oncotype DX recurrence score

et al. 2015

View full text Add to dashboard Cite

Oncotype DX (Genomic Health, Redwood City, CA, USA, current list price $4,350.00) is a multigene quantitative reverse transcription-polymerase chain reaction-based assay that estimates the risk of distant recurrence and predicts chemotherapy benefit for patients with estrogen receptor (ER)-positive breast cancers. Studies have suggested that standard histologic variables can provide similar information. Klein and Dabbs et al have shown that Oncotype DX recurrence scores can be estimated by incorporating standard histologic variables into equations (Magee equations). Using a simple modification of the Magee equation, we predict the Oncotype DX recurrence score in an independent set of 283 cases. The Pearson correlation coefficient (r) for the Oncotype DX and average modified Magee recurrence scores was 0.6644 (n = 283; Po 0.0001). 100% of cases with an average modified Magee recurrence score430 (n = 8) or an average modified Magee recurrence score o9 (with an available Ki-67, n = 5) would have been correctly predicted to have a high or low Oncotype DX recurrence score, respectively. 86% (38/44) of cases with an average modified Magee recurrence score ≤ 12, and 89% (34/38) of low grade tumors (NS o6) with an ER and PR ≥ 150, and a Ki-67 o 10%, would have been correctly predicted to have a low Oncotype DX recurrence score. Using an algorithmic approach to eliminate high and low risk cases, between 5% and 23% of cases would potentially not have been sent by our institution for Oncotype DX testing, creating a potential cost savings between $56,550.00 and $282,750.00. The modified Magee recurrence score along with histologic criteria may be a cost-effective alternative to the Oncotype DX in risk stratifying certain breast cancer patients. The information needed is already generated by many pathology laboratories during the initial assessment of primary breast cancer, and the equations are free. Breast cancer is the most common non-cutaneous cancer in women, and the second most frequent cause of cancer death among women. 1 Approximately 50% of breast cancer cases are estrogen receptor (ER)-positive. 2 A major challenge in the treatment planning for breast cancer is to identify those patients who are more likely to develop recurrence, so that the most appropriate therapeutic regimen can be provided. The decisions around systemic therapy in breast cancer have traditionally been based on combinations of clinical and histopathologic risk factors including measures of proliferation, 3 tumor size, 4 histologic grade, 5 as well as lymph node staging. 6 In addition, breast cancer biomarkers including ER, progesterone receptor (PR), and the human epidermal growth factor receptor-2 (HER-2), are routinely assessed to provide further prognostic information as well as to help identify subsets of patients who are appropriate for specific targeted therapies. 7-9 These prognostic markers are very useful for identifying the higher risk triple negative or HER-2-positive cases; however, it remains challenging to accurately assess individ...

show abstract

Section: Modern Pathology (2015) 28 921-931supporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Use of modified Magee equations and histologic criteria to predict the Oncotype DX recurrence score

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Co prawda, raki luminalne A mają średni indeks Ki67 niższy niż luminalne B (1-29%) [14,15], ale to nie zna czy, że Ki67 rozróżnia te typy, są to bowiem zbiory jedynie częściowo zachodzące na siebie. Kwalifikacja Ki67 stała się standardem diagnostycznym, jednak powtarzalność tej me tody jest krytykowana i nawet dychotomiczny podział (niski Ki67 -wysoki Ki67) daje ponad 20% błędów [16].…”

Section: Raki Luminalne B -Niejasności Nomenklaturoweunclassified

Znaczenie receptora progesteronowego w luminalnych rakach piersi

Kuncman¹,

Braun²,

Kordek³

2016

Nowotwory. Journal of Oncology

View full text Add to dashboard Cite

W praktyce klinicznej raki piersi luminalne B utożsamiane są z posiadającymi receptor estrogenowy, brakiem recep tora HER2 oraz z brakiem lub niskimi poziomami receptora progesteronowego, ewentualnie z wysokim indeksem Ki67. Rzeczywista klasyfikacja molekularna raków piersi jest oparta o różnice w ekspresji całego panelu genów, nie tylko związanych z powyższymi receptorami, jednak dla celów klinicznych przyjęto uproszczony podział. Raki typu luminalnego B to w klasyfikacji klinicznej raki z ekspresją ER, jednak z gorszym rokowaniem. Coraz częściej w piś miennictwie sugeruje się, że raki luminalne B stanowią grupę, w której aktywacja receptora estrogenowego nie jest kluczowa, a "siłą napędową" nowotworu są inne szlaki czynników wzrostu, związane na przykład z nabłonkowym czynnikiem wzrostu (EGF), insulinopodobnym czynnikiem wzrostu (IGF) czy czynnikiem wzrostu fibroblastów (FGF). Złożoności dodają liczne interakcje różnych czynników wzrostu z innymi receptorami. Przedstawione w tym artykule rozważania są podstawą do pełniejszego zrozumienia heterogenności raka piersi oraz są punktem wyjścia do dalszego pogłębiania wiedzy na ten temat. Role of progesterone receptor in luminal breast cancersIn clinical practice luminal B breast tumours are characterised by having estrogen receptor, the absence of HER2, and a lack or low levels of progesterone receptor, optionally with a high index of Ki67. However, the actual molecular classification of luminal cancers is based on differences in the expression of the whole panel of genes, not only those related to the above mentioned receptors. Luminal B cancers, are in fact, estrogen receptor positive tumours, but with worse outcome. Recently, it is frequently suggested that the luminal B tumours are a group in which the func tion of the estrogen receptor is not critical and other pathways are overactivated, which are related with growth factors: for example epithelial (EGF), insulinlike (IGF ) or fibroblast (FGF). Surprisingly there are also many interactions between various growth factors with estrogen receptor. This paper presents the heterogeneity of breast cancer. It is also a starting point for further research.

show abstract

Ki-67, 21-Gene Recurrence Score, Endocrine Resistance, and Survival in Patients With Breast Cancer

Lee,

Bae

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceBoth high 21-gene recurrence score (RS) and high Ki-67 level are poor prognostic factors in patients with estrogen receptor (ER)–positive ERBB2-negative (ER+/ERBB−) breast cancer; however, a discrepancy between the 2 has been noted. Survival differences according to these 2 biomarkers are not well known.ObjectiveTo assess the associations between RS and Ki-67 expression and between Ki-67 expression and recurrence-free survival in patients with ER+/ERBB− breast cancer with low RS.Design, Setting, and ParticipantsThis cohort study included women treated for ER+/ERBB2− breast cancer who underwent the 21-gene RS test from March 2010 to December 2020 in 2 hospitals in Korea.ExposuresRecurrence score and Ki-67 level.Main Outcomes and MeasuresA Cox proportional hazards regression model was used to examine the association of Ki-67 with recurrence-free survival (RFS), while a binary logistic regression model was used to examine the association between Ki-67 and secondary endocrine resistance. High Ki-67 expression was defined as 20% or greater, and low genomic risk as an RS of 25 or less. Secondary endocrine resistance was defined as breast cancer recurrence that occurred after at least 2 years of endocrine therapy and during or within the first year after completing 5 years of adjuvant endocrine therapy.ResultsA total of 2295 female patients were included (mean [SD] age, 49.8 [9.3] years), of whom 1948 (84.9%) were in the low genomic risk group and 1425 (62.1%) had low Ki-67 level. The median follow-up period was 40 months (range, 0-140 months). The RS and Ki-67 level had a moderate correlation (R = 0.455; P &lt; .001). Of the patients with low Ki-67 level, 1341 (94.1%) had low RS, whereas 607 of 870 patients with high Ki-67 level (69.8%) had low RS. In patients with low RS, the RFS differed significantly according to Ki-67 level (low Ki-67, 98.5% vs high Ki-67, 96.5%; P = .002). Among the 1807 patients with low genomic risk who did not receive chemotherapy, high Ki-67 level was independently associated with recurrence (hazard ratio, 2.51; 95% CI, 1.27-4.96; P = .008). Recurrence after 3 years differed significantly according to Ki-67 level (low Ki-67, 98.7% vs high Ki-67, 95.7%; P = .003), whereas recurrence within 3 years did not differ (low Ki-67, 99.3% vs high Ki-67, 99.3%; P = .90). In addition, Ki-67 was associated with secondary endocrine resistance in patients with low RS who did not receive chemotherapy (odds ratio, 2.49; 95% CI, 1.13-5.50; P = .02).Conclusions and RelevanceIn this cohort study of patients with ER+/ERBB2− breast cancer, a moderate correlation was observed between Ki-67 and RS, and high Ki-67 level in patients with low genomic risk was associated with increased risk of secondary endocrine resistance.

show abstract

Ki 67 is a major, but not the sole determinant of Oncotype Dx recurrence score

Cited by 77 publications

References 17 publications

Use of modified Magee equations and histologic criteria to predict the Oncotype DX recurrence score

Use of modified Magee equations and histologic criteria to predict the Oncotype DX recurrence score

Znaczenie receptora progesteronowego w luminalnych rakach piersi

Ki-67, 21-Gene Recurrence Score, Endocrine Resistance, and Survival in Patients With Breast Cancer

Contact Info

Product

Resources

About