Long-Term Prognostic Performance of Ki67 Rate in Early Stage,pT1-pT2, pN0, Invasive Breast Carcinoma |
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| Authors: | Fabien Reyal David Hajage Alexia Savignoni Jean-Guillaume Feron Marc Andrew Bollet Youlia Kirova Alain Fourquet Jean-Yves Pierga Paul Cottu Veronique Dieras Virginie Fourchotte Fatima Laki Severine Alran Bernard Asselain Anne Vincent-Salomon Brigitte Sigal-Zafrani Xavier Sastre-Garau |
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| Affiliation: | 1. Department of Surgery, Institut Curie, Paris, France.; 2. Department of Biostatistic, Institut Curie, Paris, France.; 3. Départment of Radiation Oncology, Institut Curie, Paris, France.; 4. Département of Medical Oncology, Institut Curie, Paris, France.; 5. Département of Tumour Biology, Institut Curie, Paris, France.; University of Porto, Portugal, |
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| Abstract: | BackgroundMolecular signatures may become of use in clinical practice to assess the prognosis of breast cancers. However, although international consensus conferences sustain the use of these new markers in the near future, concerns remain about their degree of discordance and cost-effectiveness in different international settings. The present study aims to validate Ki67 as prognostic factor in a large cohort of early-stage (pT1–pT2, pN0) breast cancer patients.Methods456 patients treated in 1995–1996 were identified in the Institut Curie database. Ki67 (MIB1) was retrospectively assessed by immunohistochemistry for all cases. The prognostic value of this index was compared to that of histological grade (HG), Estrogen receptor (ER) and HER2 status. Distant disease free interval, loco-regional recurrence, time-lapse from first metastatic diagnosis to death were analyzed.ResultsAll 456 patients were treated by lumpectomy plus axillary dissection and radiotherapy. 27 patients (5.9%) received systemic treatment. Tumors were classified as HG1 in 35%, HG2 in 42% and HG3 in 23% of cases. ER was expressed in 86% of the tumors, HER2 in 5% and 14% were triple negative. The median follow-up was 151 [5–191] months. Distant and loco-regional disease recurrences were observed in 16% and 18%, respectively. High (>20%) Ki67 rate [HR = 3 (1.8–4.8), p<10e−06] and HG3 [HR = 4.4 (2.2–8.6), p = 0.00002] were associated with an increased rate of distant relapse. In multivariate analysis, the Ki67 remained the only significant prognostic factor in the subgroups of ER positive HER2 negative [HR = 2.6 (1.5–4.6), p = 0.0006] and ER positive HER2 negative HG2 tumors [HR = 2.2 (1.01–4.8), p = 0.04].ConclusionsWe validate the prognosis value of the Ki67 rate in small size node negative breast cancer. We conclude that Ki67 is a potential cost-effective decision marker for adjuvant therapy in early-stage HG2, pT1–pT2, pN0, breast cancers. |
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