Ki-67 immunostaining in node-negative stage I/II breast carcinoma. Significant correlation with prognosis

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Abstract
Prognostic predictors for node‐negative breast carcinoma have not been clearly established. Immunostaining with Ki‐67 antibody was performed on frozen sections of histologically proved node‐negative breast carcinomas from 42 patients to examine its prognostic value and its association with other clinicopathologic and biochemical parameters, i.e., patient age and tumor size, histologic type, nuclear grade, mitotic rate, presence of vascular or lymphatic invasion, DNA ploidy, percentage of cells in S‐phase, estrogen content, and c‐erbB‐2 amplification. Thirty‐seven of the 42 tumors showed immunoreactivity with Ki‐67 antibody in 1% to 55% of the tumor cells. A strongly significant correlation was observed between Ki‐67 staining percentage and, respectively, nuclear grade, age, and mitotic rate. Nuclear grade 1 (the most anaplastic) tumors showed a significantly higher median percentage of cells stained (median, 14; range, 3 to 40) compared with nuclear grade 3 tumors (median, 0.5; range, 0 to 8). Thirteen patients developed recurrence; six of them died of disease. On univariate analysis, both 5‐year disease‐free and overall survivals were strongly associated with percentage of cells stained with Ki‐67 antibody. Our results suggest that Ki‐67 immunostaining correlates well with nuclear grade and clinical outcome in node‐negative breast carcinoma. Because of small sample size analyzed in this study we were unable to do multivariate analysis. Therefore, further studies with larger number of cases are needed to determine whether tumor proliferative activity determined by Ki‐67 immunostaining is an independent prognostic parameter or it merely reflects histopathologic features such as nuclear grade or mitotic activity.