The utility of mitotic index, oestrogen receptor and Ki-67 measurements in the creation of novel prognostic indices for node-negative breast cancer
The utility of mitotic index, oestrogen receptor and Ki-67 measurements in the creation of novel prognostic indices for node-negative breast cancer
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DOI：
10.1053/ejso.1999.0657
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发表时间：
1999-08-01
期刊：
影响因子：
--
通讯作者：
van de Vijver, MJ
中科院分区：
文献类型：
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作者：
Clahsen, PC;van de Velde, CJH;van de Vijver, MJ
前言：预后因素可用于确定淋巴结阴性患者复发风险增加，应接受辅助治疗。在过去，雌激素受体状态和有丝分裂指数已被证明是预后的重要预测因素。可以使用不同的技术来测量这些预后因素。方法：研究了来自441名绝经前淋巴结阴性乳腺癌患者的石蜡包埋肿瘤标本，这些患者之前被随机分配到一项比较围手术期化疗与无进一步治疗的试验中。雌激素受体状态通过经典的生物化学测定和免疫组织化学（ER-IA）测定。核分裂指数通过计数核分裂数和计算Ki-67抗体阳性肿瘤细胞的百分比来评估。ER IA与ER生化测定、Ki-67阳性肿瘤细胞百分率及核分裂计数均具有良好的相关性（P <0.01）。然而，ER-IA显著预测无病生存期（RR = 2.67，95% CT：1.60-4.44，P < 0.01），而生化测定仅具有边缘显著性（RR = 1.54，95% CI：1.00-2.36，P = 0.05）。Ki-67与核分裂相计数（RR = 1.56，95%CI：1.22-2.00，P < 0.01）相比，Ki-67是一个更强的预后指标（RR = 2.84，95%CI：1.80-4.48，P < 0.01）。我们的结论是ER-IA比经典的生化雌激素受体测定更好地预测预后。Ki-67是一种更准确的肿瘤细胞增殖标记物，比有丝分裂计数更能预测乳腺癌患者的预后。
Introduction: Prognostic factors can be useful to identify node-negative patients at increased risk of relapse who should receive adjuvant treatment. In the past, oestrogen receptor status and mitotic index have been shown to be significant predictors of prognosis. Different techniques for the measurement of these prognostic factors are available.Methods: Paraffin-embedded tumour specimens from 441 pre-menopausal patients with node-negative breast cancer who were previously randomized onto a trial comparing peri-operative chemotherapy with no further therapy were studied. Oestrogen receptor status was determined by the classical biochemical assay and by immunohistochemistry (ER-IA). Mitotic index wits assessed by counting the number of mitoses and by calculating the percentage of tumour cells positively staining for the antibody Ki-67.Results. There was a good correlation between ER-IA and the biochemical ER-assay (P < 0.01), and the percentage of Ki-67 positive tumour cells and mitotic counts (P < 0.01) respectively. However, ER-IA significantly predicted disease-free survival (RR = 2.67, 95% CT: 1.60-4.44, P < 0.01) whereas the biochemical assay was only borderline significant (RR = 1.54, 95% CI: 1.00-2.36, P = 0.05). Similarly, Ki-67 was a stronger indicator of prognosis (RR = 2.84, 95% CI: 1.80-4.48, P < 0.01) than mitotic counts (RR = 1.56, 95% CI: 1.22-2.00, P < 0.01).Conclusions. We conclude that ER-IA performs better in predicting prognosis than the classical biochemical oestrogen receptor assay. Ki-67 is a more accurate marker for tumour cell proliferation and predicts prognosis of patients with breast cancer better than do mitotic counts.