Pc. Clahsen et al., The utility of mitotic index, oestrogen receptor and Ki-67 measurements inthe creation of novel prognostic indices for node-negative breast cancer, EUR J SUR O, 25(4), 1999, pp. 356-363
Introduction: Prognostic factors can be useful to identify node-negative pa
tients at increased risk of relapse who should receive adjuvant treatment.
In the past, oestrogen receptor status and mitotic index have been shown to
be significant predictors of prognosis. Different techniques for the measu
rement of these prognostic factors are available.
Methods: Paraffin-embedded tumour specimens from 441 pre-menopausal patient
s with node-negative breast cancer who were previously randomized onto a tr
ial comparing peri-operative chemotherapy with no further therapy were stud
ied. Oestrogen receptor status was determined by the classical biochemical
assay and by immunohistochemistry (ER-IA). Mitotic index wits assessed by c
ounting the number of mitoses and by calculating the percentage of tumour c
ells positively staining for the antibody Ki-67.
Results. There was a good correlation between ER-IA and the biochemical ER-
assay (P < 0.01), and the percentage of Ki-67 positive tumour cells and mit
otic counts (P < 0.01) respectively. However, ER-IA significantly predicted
disease-free survival (RR = 2.67, 95% CT: 1.60-4.44, P < 0.01) whereas the
biochemical assay was only borderline significant (RR = 1.54, 95% CI: 1.00
-2.36, P = 0.05). Similarly, Ki-67 was a stronger indicator of prognosis (R
R = 2.84, 95% CI: 1.80-4.48, P < 0.01) than mitotic counts (RR = 1.56, 95%
CI: 1.22-2.00, P < 0.01).
Conclusions. We conclude that ER-IA performs better in predicting prognosis
than the classical biochemical oestrogen receptor assay. Ki-67 is a more a
ccurate marker for tumour cell proliferation and predicts prognosis of pati
ents with breast cancer better than do mitotic counts.