Original Stage I's with high KI-67 that progressed?

Montana · 06-04-2007, 08:22 AM

My onc has always been concered because of my high KI-67 (35%). I wonder why I didn't get Herceptin if he was so concerned????

In light of the meta-analysis coming out at ASCO..."Ki-67 is present in all proliferating cells and has attracted scientists' interest as a marker of proliferation. It has also featured in several 'proliferation signatures' identified using genetic microarrays.

In the study overall, patients with a Ki-67-positive tumor had a 93% increased risk of relapse and a 95% increased risk of death, compared with Ki-67-negative patients."

I would like to know if there are any of you out there that originally began as Stage I and progressed or recurred?

Sheila · 06-04-2007, 09:25 PM

I was stage one and recurred, the history is in my signature. I will get my lab reports and see what my KI-67 was...seems it was high. I recurred in a year and a half.

Yorkiegirl · 06-05-2007, 06:41 AM

HMM I'm not Stage 1, but Stage 3, and my ki67 is 78%.

Montana · 06-05-2007, 07:57 AM

Thank you Sheila and Yorkiegirl for your input. With the few number of replies, it seems that maybe a high KI-67 doesn't correlate to such high recurrence rates after all...

janet11 · 06-05-2007, 10:33 AM

Well, this isn't much of a scientific survey anyway (*smile*). I figure that it's just 'one more factor' to be considered. It's not a guarantee that it'll recur.

Good luck,
Janet

julierene · 06-05-2007, 10:39 AM

How do you get KI-67 tested?

Lani · 06-08-2007, 03:10 AM

1: Virchows Arch. 2007 Jun 7; [Epub ahead of print]
Ki-67 expression in primary breast carcinomas and their axillary lymph node metastases: clinical implications.

Park D, Kåresen R, Noren T, Sauer T.
Department of Pathology, Ullevaal University Hospital, Kirkeveien 166, N-0407, Oslo, Norway, daehoon.park@ulleval.no.
Proliferative activity of tumour cells assessed by immunohistochemical Ki-67 expression is one of several prognostic indicators in breast cancer. The major objective of this study was to investigate the prognostic impact of Ki-67 proliferative activity in the axillary lymph node metastases and in the matched primary breast carcinoma from 194 patients. There was a statistically significant up-regulation of Ki-67 protein in the metastatic deposit compared to where the primary tumour was found (p = 0.001). A low Ki-67 index in both the primary and the metastatic tumours was a favorable prognostic factor. A high index in both primary and metastatic lesion and an up-regulation from a low index in the primary tumour to a high index in the metastatic deposit represented an unfavorable prognostic factor. Multivariate analysis showed that Ki-67 expression in the metastases was a superior independent prognostic factor of clinical outcomes compared to that in the primary tumours. Ki-67 expression in >/=10% of carcinoma cells in the primary tumours and >/=15% in the nodal metastases seems to be optimal cut-off levels. Ki-67 is of value as an independent prognostic factor in breast cancer.
PMID: 17554555 [PubMed - as supplied by publisher]

Hopeful · 06-08-2007, 09:42 AM

In addition to being a prognostic factor, I have read studies that consider Ki-67 predictive for response to certain therapies, like AI's and chemo. The biggest problem seems to be a lack of standardization for testing (ala her2 a few years ago).

Hopeful

CLTann · 06-08-2007, 02:44 PM

What is KI67? I have never heard of this test. I looked back my path report and found nothing mentioned about KI67. In order to find out where I stand, is it now too late (21 month after mastectomy) to do the test? Is it better to let the issue un-answered?

shelli · 06-08-2007, 03:18 PM

The ki67 has to do with the proliferation rate (unruly growth/agressiveness) of the cells of the tumor. It is looked upon with other prognostic factors of how a tumor behaves and helps Docs determine best treatment course / how agressive to be with chemo/etc. and predicted outcomes. Again, its still a guessing game with statistics. If the lab still has your original Biopsy or surgical pathology slides which they are required to maintain for several years then they may be able to still test for this. I don't know the specific details but speak to your Doc & Path. lab to determine the feasability.
Good Luck!

Adriana Mangus · 06-08-2007, 03:37 PM

Dear Montana: My returned almost 10 years after, what I hear is that 50% of all bc will return, no matter what. Is just a matter of time. I did not know anything about HER2 since I was initially dx in 94 and there was no test for it.

KI-67? Maybe the onc knows mine, but I do not remember him discussing any
KI with me. What is it? Is this a type of gene? Can I have it done now-does it matter?

Thanks to all who take the time to answer this question.

With much love.

Hopeful · 06-08-2007, 07:31 PM

Here is an excerpt from an article on Measuring Proliferation in Breast Cancer:

The Ki67 labelling index is now widely used as the measure of proliferation. Ki67 is a protein expressed in the nucleus during the cell cycle [22]. Cells express the antigen during G1, S, G2 and M phases, but not during G0. The original antibodies raised against Ki67 required fresh or frozen tumour specimens. Cells that showed specific nuclear staining were scored as positive and the Ki67 labelling index was expressed as the percentage of the total number of tumour cells that stain positive; this equates to the growth fraction of the tumour. Higher grade cancers have higher Ki67 indices – one study found mean scores of 9% in grade I tumours, 14% in grade II and 26% in grade III [23]. The Ki67 index correlates significantly with estimates of the mitotic index [24] and SPF by flow cytometry [13,25,26], although some of the published correlation coefficients are modest (r = 0.42 [13], r = 0.22 [26]). Various studies have shown correlations between Ki67 and disease-free and overall survival, with an increased risk of recurrence in tumours with a high Ki67 [27-33]. Pierga and colleagues [34] performed a multivariate analysis and showed the Ki67-determined growth fraction to be an independent prognostic factor (p = 0.03) along with nodal status, age and adjuvant treatment received.

Hope this is useful.

Hopeful

CLTann · 06-09-2007, 05:18 AM

Thank you very much Hopeful for explaining and citing reference on the Ki67 index. One more question: if Ki67 correlates well with the grading system, would the grading score be just as good a measure for the proliferation status?

Thanks.

Hopeful · 06-09-2007, 07:27 AM

CLTann,

The grading system is actually an average of three different dimensions of the tumor: cell divison or proliferation, cell structure, and nuclear grade. Each of these elements gets a score from 1 to 3. Theoretically, you could have a tumor that was scored highly on the two non-proliferation elements, yet was very slowly dividing. In that case, the Ki-67 probably would not correlate well with the grade. The text from the article I posted reflects that, as a general rule, the higher the grade, the more proliferative the tumor, which seems logical. Whether grade alone can be seen as a surrogate for proliferation is probably pushing the envelope a bit. For example, my own pathology has an aggressive element (Her2 3+ by IHC) but relatively low proliferation (Ki-67 11%), and the pathogist assigned a grade II based on the three elements. The feature that was scored the highest on my report was neither the proliferation nor the nuclear grade, but the cell structure - apparently my tumor cells were highly undifferentiated, meaning that if they were able to take up residence in a "new neigborhood," so to speak, they would have little problem blending in. What I take from the entire Ki-67 discussion is that there is no single element that we can point to that will lead to a definitive answer - there are just a million pieces to a jigsaw puzzle, and no one knows how they all come together yet.

Hopeful