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Ki67 measured in metastatic tissue and prognosis in patients with advanced breast cancer

  • Epidemiology
  • Published:
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Abstract

The purpose of this study is to determine the prognostic role of Ki67 evaluated in relapse biopsies from patients with metastatic breast cancer (MBC). Two hundred and ten patients diagnosed with MBC in Stockholm, Sweden between 1998 and 2009 and with Ki67 assessed at time of first systemic relapse (mKi67) were retrospectively identified and divided into two groups according to mKi67 fraction (low ≤20 %, high >20 %). Post-relapse survival was compared between the groups using Kaplan–Meier and Cox regression methods. Death rate as function of continuous mKi67 was also evaluated. Furthermore, the prognostic role of intra-individual change in Ki67 between primary tumor and matched metastasis was explored by Kaplan–Meier plots. One hundred and twenty-five patients had low and 85 had high mKi67. Median survival was 25 and 17 months in low- and high-mKi67 group, respectively [hazard ratio (HR) 0.69, 95 % confidence intervals (CI) 0.51–0.92, P = 0.01]. In a multivariate model adjusted for prognostic confounders, low-mKi67 showed a non-significant trend toward better survival (HR 0.85, 95 %CI 0.62–1.16, P = 0.30). Nevertheless, mKi67 independently correlated with survival when compared with primary tumor proliferation (HR 0.56, 95 %CI 0.38–0.81, P = 0.002). The 2-year death rate steeply increased as mKi67 increased. Moreover, the change from high in primary tumor to low in metastasis significantly correlated with longer survival when compared with stable Ki67 levels (HR 0.48, 95 %CI 0.31–0.76, P = 0.002). In this cohort of MBC patients, mKi67 inversely but not independently correlated with survival. However, a significant association between mKi67 and survival was shown regardless of primary tumor proliferation.

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Abbreviations

CI:

Confidence intervals

EBC:

Early breast cancer

ER:

Estrogen receptor

FNAC:

Fine-needle aspiration cytology

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

MBC:

Metastatic breast cancer

mKi67:

Ki67 measured in metastasis

OS:

Overall survival

pKi67:

Ki67 measured in primary tumor

PR:

Progesterone receptor

RFI:

Recurrence-free interval

TMAs:

Tissue microarray sections

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Acknowledgments

We would like to thank Dr. Ulla Wilking for her help in data collection. This Research Project was supported by the European Society of Medical Oncology (ESMO) “Translational Research Fellowship” to Dr. Falato, the “Umberto Veronesi” Foundation, the Breast Cancer Theme Center (BRECT) at Karolinska Institutet, the Swedish Cancer Foundation, the Cancer Society in Stockholm, the Swedish Research Council, and the Stockholm County Council. Any views, opinions, findings, conclusions, or recommendations expressed in this material are those solely of the authors and do not necessarily reflect those of the above-mentioned organizations.

Conflict of interests

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Claudette Falato, Julie Lorent, Edneia Tani, Eva Karlsson, Jonas Bergh & Theodoros Foukakis

  2. Department of Histopathology and Cytopathology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK

    Paul K. Wright

  3. Department of Oncology and Pathology, CCK, R8:03, Karolinska University Hospital, 17176, Stockholm, Sweden

    Edneia Tani, Jonas Bergh & Theodoros Foukakis

Authors
  1. Claudette Falato
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  2. Julie Lorent
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  3. Edneia Tani
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  4. Eva Karlsson
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  5. Paul K. Wright
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  6. Jonas Bergh
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  7. Theodoros Foukakis
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Correspondence to Claudette Falato.

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Falato, C., Lorent, J., Tani, E. et al. Ki67 measured in metastatic tissue and prognosis in patients with advanced breast cancer. Breast Cancer Res Treat 147, 407–414 (2014). https://doi.org/10.1007/s10549-014-3096-2

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  • DOI: https://doi.org/10.1007/s10549-014-3096-2

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