Prognostic Value of Breast Cancer Subtypes, Ki-67 Proliferation Index, Age, and Pathologic Tumor Characteristics on Breast Cancer Survival in Caucasian Women

Abstract

Estrogen receptor (ER), progesterone receptor (PR), and epidermal growth factor receptor 2 (HER2) status are well-established prognostic markers in breast cancer management. The triple negative breast carcinoma subtype (ER-/PR-/HER2-) has been associated with worse overall prognosis in comparison with other subtypes in study populations consisting of ethnic minorities and young women. We evaluated the prognostic value of breast cancer subtypes, Ki-67 proliferation index (Ki-67PI), and pathologic tumor characteristics on breast cancer survival in Caucasian women in our institution, where greater than 90% of the total patient population is white. From 628 new invasive breast cancer cases in our data base (2000-late 2004), 593 (94%) were identified in Caucasian women. ER/PR/HER2 breast cancer subtypes were classified based on St. Gallen International Expert Consensus recommendations from 2011. ER/PR/HER2 status and its effect on survival were analyzed using a Kaplan-Meier curve. ER/PR/HER2 status, grade, tumor-node-metastasis status (TNM)/anatomic stage, and age were analyzed in terms of survival in a multivariate fashion using a Cox regression. Ki-67PI was analyzed between ER/PR/HER2 groups using the Kruskal-Wallis, Mann-Whitney U-tests, and 2 × 5 ANOVA. Our results showed that patients with stage IIB through stage IV breast carcinomas were 2.1-16 times more likely to die than patients with stages IA-B and IIA disease, respectively (95% CI 1.17-3.81 through 9.68-28.03, respectively), irrespective of ER/PR/HER2 subtype. Similar effect was seen with T2, N2/N3, or M1 tumors in comparison with T1, N0/N1, and M0 tumors. Chances of dying increase approximately 5% for every year increase in age. There was a significant main effect of Ki-67PI between ER/PR/HER2 subtypes, p < .001, but Ki-67PI could not predict survival. In summary, TNM status/anatomic stage of breast carcinomas and age are predictive of survival in our patient population of Caucasian women, but breast carcinoma subtypes and Ki-67 proliferation index are not.

Ki67 Index in Breast Cancer: Correlation with Other Prognostic Markers and Potential in Pakistani Patients

“…This study also confirms the value of Ki67 evaluation as an objective means for prediction of prognosis as other recently published studies (Ferguson et al, 2013;Reyel et al, 2013;Strand et al, 2013).…”

Outcomes in Patients with pT1-T2, pN0-N1 Breast Cancer After Conservative Surgery and Whole-breast Radiotherapy

“…In our database pathological, immunohistochemistry data and information about chemotherapy and hormonal and radiation therapy were collected. Several studies have shown that some variables such as age, grading, receptor status, and chemotherapy are independent risk factors for LRR (18). In our study, no significant correlations were found between these variables and LRR, OS and DFS, with the exception of PR expression in regard to better LRR (p=0.011).…”

“…Ki67 is an emerging prognostic factor that seems to adversely influence outcome of patients with N1 disease; Ferguson and colleagues have shown that the proliferative index is one of the most important prognostic factors, but as yet it is not possible to tailor therapies according to the Ki67 value (18). In our study, the Ki67 index at the cut-off of >14% did not appear to affect DFS nor LRR.…”

“…The unclear role of tumor size was reported in literature showing that, although requiring the same therapeutic management, T1 and T2 stages cannot be considered equivalent, and they presumably require two different therapeutic approaches (18).…”

Decreased expression of the CHD5 gene and its clinicopathological significance in breast cancer: Correlation with aberrant DNA methylation

“…CHD5 was more frequently methylated in breast tumor samples with ER/PR (or both) negative status than in samples with ER/PR (or both) positive status. The ER/PR status has been recognized as a prognostic factor in patients with breast carcinoma, and has been noted to be a predictive marker for the response to treatment with endocrine therapy (27). The presence of ER and PR is predictive of the response to treatment with the anti-estrogen drug tamoxifen (28).…”