Abstract
Purpose
1% of all breast cancer cases occur in men. There are significant differences regarding clinical behaviour and genetic profiles between female (FBC) and male breast cancer (MBC). Parameters for decision-making on treatment and prognosis are derived from FBC. Ki67 has a high value as a prognostic and predictive factor in FBC, but accurate Ki67 cut-off points for MBC are missing. In this study, we aimed to evaluate adequate examination methods and reliable cut-off points for Ki67 to assess the highest prognostic value for patient’s overall survival (OS).
Methods
In this multicentric retrospective study, histological specimens were obtained from 104 male patients who were diagnosed and treated for primary invasive breast cancer. We applied three methods of Ki67 analysis: Tumor average scoring (TA), tumor border scoring (TB) and hot-spot scoring (HS). Calculated Ki67 cut-off points for each method were assessed as a threshold for patients’ overall survival (OS).
Results
Ki67 cut-off points were 13.5 for the TA group, 22.5 for the HS group and 17.5 for the TB group. Only Ki67 TA cut-off calculations demonstrated statistical significance (p = 0.04). Ki67 expression analysis of TA showed that more than 90% of patients with low Ki67 levels (< 13.5) were alive after 5-year follow-up.
Conclusion
Our findings demonstrate that determination of Ki67 expression in TA is the most reliable to define a cut-off point with high prognostic value. A Ki67 cut-off point of 13.5 shows highest statistical power to define luminal A subgroup and OS.
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Acknowledgements
The authors would like to thank Mr. Guido Luechters, Center of Development Research, University Bonn, Germany and Mr. Bernardo Erices for supporting the statistical calculations.
Funding
This work was supported by the German Cancer Foundation (Project Number: 70-3157).
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All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) our work. They have no conflict of interest.
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The patient data, histopathological findings as well as treatment reports and follow-up data were collected with the approval of the appropriate institutional review boards from the hospital archives. The study was approved by the institutional local ethics committee. Data were blinded for statistical evaluations.
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Erices-Leclercq, M., Lubig, S., Förster, F. et al. Prognostic relevance of Ki67 expression in primary male breast cancer: determination of cut-off points by different evaluation methods and statistical examinations. J Cancer Res Clin Oncol 148, 441–447 (2022). https://doi.org/10.1007/s00432-021-03623-5
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DOI: https://doi.org/10.1007/s00432-021-03623-5