Ki67 Index in Breast Cancer: Correlation with Other Prognostic Markers and Potential in Pakistani Patients
Ki67 Index in Breast Cancer: Correlation with Other Prognostic Markers and Potential in Pakistani Patients
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DOI：
10.7314/apjcp.2013.14.7.4353
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发表时间：
2013-01-01
影响因子：
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通讯作者：
Faridi, Naveen
中科院分区：
文献类型：
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作者：
Haroon, Saroona;Hashmi, Atif Ali;Faridi, Naveen
前言：乳腺癌的侵袭性与肿瘤细胞的增殖状态有关，可通过肿瘤分级和Ki67指数来确定。然而，由于缺乏重复性，ASCO不建议在新诊断的乳腺癌中常规使用Ki67来判断预后。因此，我们的目标是确定Ki67指数与其他预后指标的相关性，如肿瘤大小、分级、淋巴结转移、ER、PR和HER2Neu状态。方法：选择194例初诊乳腺癌患者为研究对象。采用DAKO-ENVISION方法进行ER、PR、HER2Neu、Ki67免疫组织化学染色。Ki67指数与其他预后因素的相关性被评估为连续变量和分类变量。结果：患者平均年龄51.7岁(24~90岁)。Ki67指数平均为26.9%(1~90)。ER、PR、HER2Neu阳性分别为90/194例(46.4%)、74/194例(38.1%)和110/194例(56.70%)。Ki67的表达与肿瘤分级、PR、HER2Neu阳性及淋巴结状态显著相关，而与ER阳性及肿瘤大小无关。Ki67指数与PR阳性呈负相关，与HER2Neu阳性呈正相关。然而，与中等Ki67(16%-30%)相比，高Ki67(>；30%)与HER2Neu阳性降低相关。在淋巴结转移方面也有同样的趋势。结论：Ki67与其他预后标志物联合检测对高级别肿瘤的临床应用价值更大，因为我们发现Ki67高于30%的肿瘤比Ki67水平中等的肿瘤有更好的预后，这体现在淋巴结转移率和HER2Neu的表达略低。因此，我们建议在考虑辅助化疗和预后分层时，应将Ki67指数分为高、中、低三组。
Introduction: Breast cancer aggressiveness can be correlated with proliferation status of tumor cells, which can be ascertained with tumor grade and Ki67 indexing. However due to lack of reproducibility, the ASCO do not recommend routine use of Ki67 in determining prognosis in newly diagnosed breast cancers. We therefore aimed to determine associations of the Ki67 index with other prognostic markers like tumor size, grade, lymph node metastasis, ER, PR and HER2neu status. Methods: A total of 194 cases of newly diagnosed breast cancer were included in the study. Immunohistochemical staining for ER, PR, HER2neu and Ki67 was performed by the DAKO envision method. Associations of the Ki67 index with other prognostic factors were evaluated both as continuous and categorical variables. Results: Mean age of the patients was 51.7 years (24-90). Mean Ki67 index was 26.9% (1-90). ER, PR, HER2neu positivity was noted in 90/194 cases (46.4%), 74/194 cases (38.1%) and 110/194 cases (56.70%) respectively. Significant association was found between Ki67 and tumor grade, PR, HER2neu positivity and lymph node status, but no link was apparent with ER positivity and tumor size. There wasan inverse relation between Ki67 index and PR positivity, whereas a direct correlation was seen with HER2neu positivity. However, high Ki67 (>30%) was associated with decreased HER2neu positivity as compared to intermediate Ki67 (16-30%). The same trend was established with lymph node metastasis. Conclusion: Our study indicates that with high grade tumors, clinical utility of ki67 is greater in combination with other prognostic markers because we found that tumors with Ki67 higher than 30% have better prognostic profile compared to tumors with intermediate Ki67 level, as reflected by slightly lower frequency of lymph node metastasis and HER2neu expression. Therefore we suggest that Ki67 index should be categorized into high, intermediate and low groups when considering adjuvant chemotherapy and prognostic stratification.