The combination of Ki67, histological grade and estrogen receptor status identifies a low-risk group among 1,854 chemo-naïve women with N0/N1 primary breast cancer
1 Lund University, Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Barngatan 2B, SE-221 85, Lund, Sweden
2 Department of Pathology, Odense University Hospital, Odense, DK-5000, Denmark
3 Unilabs, Mammography, Bergaliden, SE-252 23, Helsingborg, Sweden
4 Department of Surgery, Helsingborg Hospital, SE-281 85, Helsingborg, Sweden
5 Uppsala University, Department of Oncology, Radiology and Clinical Immunology, SE-751 85, Uppsala, Sweden
6 Lund University, Department of Pathology, Skåne University Hospital, SE-221 85, Lund, Sweden
7 Division of Pathology, Department of Clinical Sciences Lund, Lund University, SE-221 85, Lund, Sweden
8 Skåne Department of Oncology, Skåne University Hospital, SE-221 85, Lund, Sweden
9 Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Department of Clinical Pathology and Clinical Genetic, County Council of Östergötland, Linköping University, Molecular and Immunological Pathology, SE-581 91, Linköping, Sweden
10 Lund University, Division of Surgery, Department of Clinical Sciences Lund, Skåne University Hospital, SE-221 85, Lund, Sweden
11 Linköping University, Division of Oncology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, County Council of Östergötland, SE-581 85, Linköping, Sweden
SpringerPlus 2013, 2:111 doi:10.1186/2193-1801-2-111Published: 14 March 2013
The aim was to confirm a previously defined prognostic index, combining a proliferation marker, histological grade, and estrogen receptor (ER) in different subsets of primary N0/N1 chemo-naïve breast cancer patients.
In the present study, including 1,854 patients, Ki67 was used in the index (KiGE), since it is the generally accepted proliferation marker in clinical routine. The low KiGE-group was defined as histological grade 1 patients and grade 2 patients which were ER-positive and had low Ki67 expression. All other patients made up the high KiGE-group. The KiGE-index separated patients into two groups with different prognosis. In multivariate analysis, KiGE was significantly associated with disease-free survival, when adjusted for age at diagnosis, tumor size and adjuvant endocrine treatment (hazard ratio: 3.5, 95% confidence interval: 2.6–4.7, P<0.0001).
We have confirmed a prognostic index based on a proliferation marker (Ki67), histological grade, and ER for identification of a low-risk group of patients with N0/N1 primary breast cancer. For this low-risk group constituting 57% of the patients, with a five-year distant disease-free survival of 92%, adjuvant chemotherapy will have limited effect and may be avoided.