Abstract
Objective While the value of Ki-67 has been recognized in breast cancer, controversy also exists. The goal of this study is to show the prognostic value of Ki-67 according to progesterone receptor (PgR) expression in patients who have estrogen receptor- (ER-) positive, human epidermal growth factor receptor 2- (HER2-) negative early breast cancer. Methods The records of nonmetastatic invasive breast cancer patients who underwent surgery at a single institution between 2009 and 2012 were reviewed. Primary end point was recurrence-free survival (RFS), and secondary end point was overall survival (OS). Ki-67 and PgR were assessed with immunohistochemistry for the tumor after surgery. Results A total of 1848 patients were enrolled in this study. 223 (12%) patients had high (≥10%) Ki-67, and 1625 (88%) had low Ki-67 expression. Significantly worse RFS and OS were observed in the high vs. low Ki-67 expression only when the PgR was low (<20%) (p < 0.001 and 0.005, respectively, for RFS and OS). There was no significant difference in RFS and OS according to Ki-67 when the PgR was high (p=0.120 and 0.076). RFS of four groups according to high/low Ki-67 and PgR expression was compared. The low PgR and high Ki-67 expression group showed worst outcome among them (p < 0.001). In a multivariate analysis, high Ki-67 was an independent prognostic factor when the PgR was low (HR 3.05; 95% CI 1.50–6.19; p=0.002). Conclusions Ki-67 had a value as a prognostic factor only under low PgR expression level in early breast cancer. PgR should be considered in evaluating the prognosis of breast cancer patients using Ki-67.
Highlights
While the value of Ki-67 has been recognized in breast cancer, controversy exists. e goal of this study is to show the prognostic value of Ki-67 according to progesterone receptor (PgR) expression in patients who have estrogen receptor- (ER-) positive, human epidermal growth factor receptor 2- (HER2-) negative early breast cancer
Node-positive and high-Histologic grade (HG) samples were identified in high Ki-67 and low PgR subsets
Consistent with previous reports, our study showed that Ki-67 expression exhibited significant prognostic value, but we further demonstrated that Ki-67 is not always an independent prognostic factor
Summary
While the value of Ki-67 has been recognized in breast cancer, controversy exists. e goal of this study is to show the prognostic value of Ki-67 according to progesterone receptor (PgR) expression in patients who have estrogen receptor- (ER-) positive, human epidermal growth factor receptor 2- (HER2-) negative early breast cancer. E goal of this study is to show the prognostic value of Ki-67 according to progesterone receptor (PgR) expression in patients who have estrogen receptor- (ER-) positive, human epidermal growth factor receptor 2- (HER2-) negative early breast cancer. Ki-67 had a value as a prognostic factor only under low PgR expression level in early breast cancer. Many studies have used Ki-67 as a presumptive independent predictive marker for treatment with prognostic value for the clinical outcome as well as disease-free and overall survival [9,10,11,12,13,14,15,16,17]. E goal of this study was to clarify the independent prognostic value of determining Ki-67 expression To this end, we investigated the relationship between Ki-67 and PgR expression levels in clinical practice and correlated the expression of these markers with clinicopathologic variables
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