Ki-67 Expression is a Significant Prognostic Factor Only When Progesterone Receptor Expression is Low in Estrogen Receptor-Positive and HER2-Negative Early Breast Cancer

الملخص EN

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.