Background: Anterior findings denoted that catechol-O-methyltransferase (COMT) have been considered as genetic risk for chemo-brain. However, the mediation of COMT polymorphism for chemo-brain in breast cancer patients with various index of ki-67 was still unknown.Objective: The current research intended to assess the genetic risk by COMT genotype for chemo-brain in breast cancer patients with various index of ki-67.Methods: Breast cancer patients (65 with ki-67<14%, 75 with ki-67>14%) fulfilled cognitive tests pre and post adjuvant chemotherapy, three single-nucleotide polymorphisms (SNPs) of COMT (rs165599, rs4680, rs737865) were genotyped by furnishing peripheral blood.Results: The lower cognitive of breast cancer patients were displayed in compared with those before chemotherapy. Further, the event-based prospective memory (EBPM) scores of ki-67>14% group patients were worse than those of ki-67<14% group patients after chemotherapy (z=-7.51, p<0.01), but the time-based prospective memory (TBPM) scores of two groups were no significant difference. The COMT rs737865 A/G genotype was associated with memory protective susceptibility (co-dominant model: adjusted, OR=0.135, CI95%=0.026-0.706, p =0.018), A/G genotype carriers exhibited more well on EBPM test relative to A/A genotype. Conclusion: The index of ki-67 was likely to be associated with EBPM decline in breast cancer patients. Moreover, the COMT rs737865 polymorphism was potential genetic risk of chemo-brain in breast cancer patients with various index of ki-67.