Kang Young-Joon, Lee Han-Byoel, Kim Yun Gyoung, Han JaiHong, Kim Yumi, Yoo Tae-Kyung, Lee Eun-Shin, Moon Hyeong-Gon, Noh Dong-Young, Han Wonshik
Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Republic of Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Oncol. 2019 Dec 28;2019:7386734. doi: 10.1155/2019/7386734. eCollection 2019.
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.
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.
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%) ( < 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 (=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 ( < 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; =0.002).
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.
虽然Ki-67在乳腺癌中的价值已得到认可，但仍存在争议。本研究的目的是在雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性的早期乳腺癌患者中，根据孕激素受体（PgR）表达情况显示Ki-67的预后价值。
回顾了2009年至2012年在单一机构接受手术的非转移性浸润性乳腺癌患者的记录。主要终点是无复发生存期（RFS），次要终点是总生存期（OS）。术后用免疫组织化学法评估肿瘤的Ki-67和PgR。
本研究共纳入1848例患者。223例（12%）患者Ki-67高表达（≥10%），1625例（88%）患者Ki-67低表达。仅当PgR低（<20%）时，高Ki-67表达组的RFS和OS明显差于低Ki-67表达组（RFS和OS分别为<0.001和0.005）。当PgR高时，根据Ki-67的RFS和OS无显著差异（分别为0.120和0.076）。比较了根据高/低Ki-67和PgR表达的四组的RFS。低PgR和高Ki-67表达组的预后最差（<0.001）。在多变量分析中，当PgR低时，高Ki-67是独立的预后因素（HR 3.05；95%CI 1.50-6.19；=0.002）。
在早期乳腺癌中，Ki-67仅在低PgR表达水平下具有预后因素价值。在使用Ki-67评估乳腺癌患者预后时应考虑PgR。
