Marwah Nisha, Batra Ashima, Marwah Sanjay, Gupta Veena, Shakya Samta, Sen Rajeev
Department of Pathology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India.
Department of Surgery, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India.
J Cancer Res Ther. 2018 Apr-Jun;14(3):537-542. doi: 10.4103/0973-1482.167614.
Routine assessment of cell proliferation is recommended in the pathologic evaluation for all breast cancers. Considering the poor reproducibility and interobserver variability in mitotic counts, Ki-67 is an easily available and reliable substitute for mitotic counts and has been shown to have a significant relationship with the histologic grade of malignancy and the mitotic activity of tumors. Our study aimed at exploring Ki-67 expression and studying its correlation with other established prognostic parameters.
Seventy-five cases of primary breast cancer undergoing radical or modified radical mastectomy constituted the study group. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, and Ki-67 was assessed in each case. Ki-67 labeling index (Ki-67-LI) was estimated as the number of positive nuclei divided by total number of nuclei scanned counting a minimum of 1000 cells in 10 selected high power fields that displayed the highest immunoreactivity and was expressed as percentage. Ki-67 expression was correlated with various clinicopathologic prognostic parameters including age, tumor size, tumor type, axillary lymph node status, and histologic tumor grade.
A statistically significant direct association was observed between Ki-67-LI and tumor size, histologic grade and Nottingham prognostic index. A statistically significant inverse association was observed between Ki-67-LI and ER and PR expression. However, no association was observed between Ki-67-LI and menopausal status, lymph node involvement and HER2/neu expression.
Based on our results, we concluded that modified Bloom-Richardson (MBR) grading has been recognized as a treatment related indicator. The accuracy and reliability in grading have always been a matter of concern, hence, the reproducibility of grading should be enhanced. Ki-67-a proliferation marker is easily identified and provides comparable accurate information. In contrast to poor reproducibility of mitotic counts, Ki-67 can achieve high agreement between pathologists; is more reproducible; adds complementary value to the MBR grading system and correlates well with other clinicopathologic parameters. It may act as a significant prognostic indicator for routine clinical use and be helpful for selection of adjuvant treatment. It can also add value in categorizing Grade II tumors into two prognostic subgroups with prognosis equivalent to Grades I and III, respectively.
在所有乳腺癌的病理评估中，建议对细胞增殖进行常规评估。鉴于有丝分裂计数的可重复性差和观察者间变异性，Ki-67是一种易于获得且可靠的有丝分裂计数替代指标，并且已显示其与恶性肿瘤的组织学分级和肿瘤的有丝分裂活性存在显著关系。我们的研究旨在探索Ki-67的表达并研究其与其他既定预后参数的相关性。
75例接受根治性或改良根治性乳房切除术的原发性乳腺癌患者构成研究组。对每例患者评估雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2）/neu和Ki-67。Ki-67标记指数（Ki-67-LI）通过阳性细胞核数除以扫描的细胞核总数来估算，在10个选定的显示最高免疫反应性的高倍视野中至少计数1000个细胞，并以百分比表示。Ki-67表达与包括年龄、肿瘤大小、肿瘤类型、腋窝淋巴结状态和组织学肿瘤分级在内的各种临床病理预后参数相关。
观察到Ki-67-LI与肿瘤大小、组织学分级和诺丁汉预后指数之间存在统计学上显著的直接关联。观察到Ki-67-LI与ER和PR表达之间存在统计学上显著的负相关。然而，未观察到Ki-67-LI与绝经状态、淋巴结受累及HER2/neu表达之间存在关联。
基于我们的结果，我们得出结论，改良的布鲁姆-理查森（MBR）分级已被视为与治疗相关的指标。分级的准确性和可靠性一直是人们关注的问题，因此，应提高分级的可重复性。Ki-67——一种增殖标志物易于识别并能提供相当准确的信息。与有丝分裂计数的可重复性差相反，Ki-67能使病理学家之间达成高度一致；更具可重复性；为MBR分级系统增加了补充价值，并且与其他临床病理参数相关性良好。它可能作为常规临床使用的重要预后指标，有助于辅助治疗的选择。它还可以在将II级肿瘤分为两个预后亚组方面增加价值，其预后分别与I级和III级相当。
