你了解乳腺癌患者的Ki-67指数吗?

免疫组化抗体神器

好评必备! 免费下载

  Ki-67是由MKI67基因编码的细胞核蛋白质,Ki-67指数即该蛋白质染色阳性细胞的百分比。Ki-67指数越高,通常表明细胞分裂增殖越活跃、肿瘤生长速度越快,而抗增殖药物化疗效果也较好,故对早期乳腺癌术后辅助治疗决策至关重要。不过,Ki-67染色阳性细胞目前主要依靠病理医师通过显微镜计数,例如选5个高倍视野、每个视野数200个细胞,或者选10个高倍视野、每个视野数100个细胞,随后取平均值。这是十分枯燥繁重的工作,时间一长眼睛肯定会花。因此,大多数情况下病理医师通过经验推算,主观因素影响较大,不同病理医师之间的计数差异可能降低其可重复性,染色强度的判断标准也不统一。当然,现在图像分析软件和人工智能可以完成这项工作,不过最终还是需要人工审核。
  2020年4月14日,欧洲乳腺癌专科医师学会《乳腺》在线发表瑞士圣加仑州立医院、巴塞尔大学的研究报告,对圣加仑乳腺癌中心5年内Ki-67指数的可重复性进行了分析,并将其每年分布情况与已发表的数据集进行了比较。
  该单中心回顾研究收集2010~2014年圣加仑乳腺癌中心1154例早期乳腺癌患者的Ki-67指数,对每年Ki-67指数分布及其组织学亚型和分级进行分析。采用两种定义(2013年圣加仑共识的定义、2014年意大利米兰大学欧洲肿瘤研究院的改良定义)将肿瘤分为不同的分子亚型。对该中心的Ki-67临界值进行校正,使管腔亚型分布与2014年改良定义的数据相同。
  结果,各年Ki-67指数分布相近(平均:26~30%,中位22~26%),Ki-67指数分布曲线的形状和位置几乎相同。
  乳腺导管癌与乳腺小叶癌相比:
  ●患者比例:77%比20%
  ●Ki-67指数:22%比18%(95%置信区间:23.6~26.3、16.7~20.0)
 
  Ki-67指数的中位值与肿瘤分级成正比:
  ●1级:12%
  ●2级:21%
  ●3级:38%
 
  Ki-67指数的标准差与肿瘤分级成正比(P<0.001)
  ●1级:6.9
  ●2级:9.2
  ●3级:18.2
 
  根据2013年定义、2014年改良定义的Ki-67指数:
  ●管腔A型:35%、41%
  ●管腔B型:65%、59%
 
  为了获得与2014年改良定义数据相同的分布,Ki-67指数临界值需要提高至22%。
  因此,该研究结果表明,多年来该中心的Ki-67指数评定相近,Ki-67计数者较少而且相对固定可以提高Ki-67评定的可重复性。与已发表的数据集进行比较,有助于病理医师定义合理的Ki-67临界值。对于临床医师,了解自己医院的Ki-67指数分布及其可重复性,对于早期乳腺癌术后辅助治疗的临床决策至关重要。
  Breast. 2020 Apr 14;51:120-126. [Epub ahead of print]
  Do YOU know the Ki-67 index of your breast cancer patients? Knowledge of your institution's Ki-67 index distribution and its robustness is essential for decision-making in early breast cancer.
  Angela Fischer Maranta, Simon Broder, Constanze Fritzsche, Michael Knauer, Beat Thürlimann, Wolfram Jochum, Thomas Ruhstaller.
  St. Gallen Cantonal Hospital, St. Gallen, Switzerland; University of Basel, Basel, Switzerland.
  HIGHLIGHTS
  ●Limiting the number of observers can improve reproducibility of Ki-67 assessments.
  ●Comparison with published data-sets helps to define adequate Ki-67 cut-off levels.
  ●Lobular breast cancers have a significantly lower Ki-67 than ductal breast cancers.
  ●Ki-67 values and standard deviation increase parallel to increasing tumor grade.
  ●Ki-67, properly assessed, remains important for decision making in breast cancer.
  OBJECTIVES: The proliferative activity of the Ki-67 index is important in decision-making of adjuvant treatments in early breast cancer. Its reliability can be reduced by inter-observer variability. This analysis' objective is to evaluate the robustness of Ki-67 values within one center over 5 years and to compare its distribution with a published dataset.
  MATERIALS AND METHODS: Ki-67 indices of early breast cancers treated at St. Gallen Breast Center were collected (2010-2014; 1154 patients). Distribution of Ki-67 values was analyzed for each year, along with histologic subtype and grading. Tumors were classified into intrinsic subtypes using two definitions: 2013 St. Gallen Consensus and the refined definition by Maisonneuve ("Milano Group"). Our institution's Ki-67 cut-off value was adjusted to obtain the same distribution of luminal subtypes as published data of the Milano Group.
  RESULTS: Ki-67 index frequency distributions were comparable between years (mean 26-30%, median 22-26%). Shape and position of the distribution curves were nearly identical. Ki-67 values correlated with tumor grade (median Ki-67: G1: 12.0%, G2: 21%, G3: 38%). Standard deviation of Ki-67 increased with higher grading (G1: 6.9; G2: 9.2; G3: 18.2; p < 0.001). According to the 2013 definition (and refined definition respectively), there were 35% (41%) luminal A-like and 65% (59%) luminal B-like tumors. To obtain the same distribution as the Milano group, Ki-67 cut-off needed to be elevated to 22%.
  CONCLUSIONS: Ki-67 index assessment was comparable over many years. Knowledge of one's institution's Ki-67 value distribution is essential for clinical decision-making of adjuvant therapies in early breast cancer.
  KEYWORDS: Intrinsic subtype, Luminal type, Ki-67, Early breast cancer
  DOI: 10.1016/j.breast.2020.03.005
 





责任编辑: 奶糖
0 0 0

扫一扫下载91360客户端