Wang Changsong, Chen JingChang, Lv Xuexia, Yun Tian, Wang Yaxi, Meng Nianlong, Li Fulin, Cao Yansha, Fan Naijun, Wang Xiaoyue
Department of Pathology, People's Liberation Army Joint Logistic Support Force 989 th Hospital, Huaxia West Road, Luoyang, 471031, Henan, China.
School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China.
BMC Cancer. 2025 May 28;25(1):962. doi: 10.1186/s12885-025-14374-8.
The Ki-67 index, which is a proliferative index, has become more important in making treatment decisions for patients with breast cancer (BC) and plays both a predictive role and a prognostic role. However, a few factors limit its use in clinical practice, particularly the assessment of the percentage of Ki-67-positive cells and the cutoff value of Ki-67. In this study, we examined the expression of Ki-67 via immunohistochemistry and systematically evaluated the value of the Ki-67 index in patients with BC. This was a retrospective study including 280 patients diagnosed with BC. There were marked differences in overall survival (OS) between patients with BC when the Ki-67 index ranged from 46 to 68% (χ2 = 5.87, P = 0.0154; χ2 = 7.64, P = 0.0057, respectively), and the same results were also found when the staining density was added to the Ki-67 index; however, the staining density alone has limited value in assessing the value of Ki-67. There were marked differences in disease-free survival (DFS) among BC patients when the Ki-67 index ranged from 50 to 58% (χ2 = 7.31, P = 0.0069; χ2 = 7.88, P = 0.005). When 14% was used as a cutoff point to classify the molecular type of BC, the luminal A-type patients were significantly different from patients with HER2-overexpressing subtype BC in terms of OS (χ2 = 5.33, P = 0.021). There was a significant difference in the OS of patients with human epidermal growth factor receptor 2 (HER-2)-overexpressing subtype BC when the Ki-67 index fell within the range of 49-60% (χ2 = 4.86, P = 0.0275; χ2 = 5.50, P = 0.019, respectively). There were significant differences between luminal A-type BC and HER2-overexpressing subtype BC in terms of OS (χ2 = 5.53, P = 0.019), according to suggestions of the 2019 CSCO consensus. There were significant differences between the two groups of luminal B HER-2(-) BC when the Ki-67 index was 52% (χ2 = 6.61, P = 0.0101). The differentiated Ki-67 index can be used to assess the OS and DFS of patients with BC, and the staining density of Ki-67 has little value in assessing prognosis in these patients. Different molecular classification methods may influence the assessment of prognosis and the results of molecular subtype in patients with BC. To predict the prognosis of BC patients, it is more scientifically feasible to use the interval values of Ki-67 than a specific value.
Ki-67指数作为一种增殖指数，在乳腺癌（BC）患者的治疗决策中变得愈发重要，兼具预测和预后作用。然而，一些因素限制了其在临床实践中的应用，尤其是Ki-67阳性细胞百分比的评估以及Ki-67的临界值。在本研究中，我们通过免疫组织化学检测Ki-67的表达，并系统评估Ki-67指数在BC患者中的价值。这是一项回顾性研究，纳入了280例诊断为BC的患者。当Ki-67指数在46%至68%之间时，BC患者的总生存期（OS）存在显著差异（χ2 = 5.87，P = 0.0154；χ2 = 7.64，P = 0.0057），将染色密度纳入Ki-67指数时也得到相同结果；然而，单独的染色密度在评估Ki-67价值方面作用有限。当Ki-67指数在50%至58%之间时，BC患者的无病生存期（DFS）存在显著差异（χ2 = 7.31，P = 0.0069；χ2 = 7.88，P = 0.005）。当以14%作为BC分子类型分类的临界值时，腔面A型患者与HER2过表达亚型BC患者在OS方面存在显著差异（χ2 = 5.33，P = 0.021）。当Ki-67指数在49%至60%范围内时，人表皮生长因子受体2（HER-2）过表达亚型BC患者的OS存在显著差异（χ2 = 4.86，P = 0.0275；χ2 = 5.50，P = 0.019）。根据2019年CSCO共识建议，腔面A型BC与HER2过表达亚型BC在OS方面存在显著差异（χ2 = 5.53，P = 0.019）。当Ki-67指数为52%时，两组腔面B型HER-2（-）BC之间存在显著差异（χ2 = 6.61，P = 0.0101）。差异化的Ki-67指数可用于评估BC患者的OS和DFS，Ki-67的染色密度在评估这些患者的预后方面价值不大。不同的分子分类方法可能会影响BC患者预后评估及分子亚型结果。为预测BC患者的预后，使用Ki-67的区间值比特定值更具科学可行性。
