Ki67 question

[Shweta11]

My ki67 figure was 28%. Is this high or low. Please help, I have browsed quite a lot but got no clarity.

[kaarenorgaard]

It is generally said that Ki67 is LOW if less than 10%, INTERMEDIATE if 10-20%, and HIGH if more than 20%. So your figure according to this single classification is high. But you have to see it all in context to get a useful picture of your situation.

So please state what else is your situation, it is important:

(1) Kind of tumor (Invasive? Ductal or Lobular? Etc.), (2) Size, (3) Has it spread to the lymph nodes (if you know that at present), (4) Hormone Receptor positive (ER or PR positive), (5) HER2 positive, (6) Grade, (7) your age ... and I would then depending on these answers ask a few further questions.

And one more thing - can you get a genomic analysis of the tumor - it will tell you a lot more than the classical Ki67 number.

I would very much like to help you get clarity

Kaare (from Denmark)

[sumeet_shah Administrator in reply to kaarenorgaard]

I sincerely appreciate all your answers. We thank you for your efforts, they are highly appreciated.

A small point I want to make is that Genomic tests are not done here as a routine; first, because most patients are node positive and it is not applicable and second, of those very few where it is applicable, very very few do it as the cost of a genomic test here is MUCH MUCH MORE than the entire cost of chemotherapy combined. Insurance companies in India, as of now, unfortunately, do not reimburse these genomic tests which cost a bomb, a patient has to spend from their own pockets and this too has to be considered.

It will take another ten years, if not more, for genomic tests to become common. The reason is not that they are not prescribed, but reason is that more than 90 percent patients in India do not have insurance or have a bare minimum insurance not enough to even do one fourth of treatment. And this in turn has to do with education, and per capita income. India has a long long way to go.

[Shweta11 in reply to kaarenorgaard]

Hi Kaare,

I was not advised a genomic analysis and as per Sumeet's reply, looks like it is not done in India.

I am 30 years old, ER+ve, PR+ve and Her2-ve. It's invasive ductal carcinoma with lymph node positive, grade 2. The size is 4cm.

My current staging is 2b but only after my surgery, I will get the correct staging.

Thanks.

[kaarenorgaard in reply to Shweta11]

Hi Sweeta11,

This is much more important than the Ki67 number: the fact that it is ER+, PR+, and HER2- are all good features. Then you take some form of anti-hormone medicine (because it is ER+ and PR+) - probably Tamoxifen, and you take it for many years (5 years is typical). It is likely preceded by chemotherapy for something like 18 weeks after the surgery. Those two will effectively attack any cancer cells in your body.

The next important piece of information, which you probably receive after surgery, is the number of lymph nodes, that have cancer.

[Shweta11 in reply to kaarenorgaard]

Hi Kaare,

That's what my medical oncologist told too, 'good features'. He was looking at my KI score at the same time, so I did not know what to make out of it.

Yes, for now I am planned for 8 cycles of dense dose chemotherapy. Not sure if it is going to be 8 cycles of NACT or 4. I will be evaluated after 4 cycles of chemo for surgery.

Thanks for your encouraging words.

Greetings.

[roxboxfox RadiationOncologist]

It's a very controversial marker of cell proliferation.

Most international centre's take 15% cut off as Positive

and this is then analysed with other features which Kaare from Denmark has mentioned.

There is no other relevant info that u have provided.

Dr Rohit Malde

Reference:

ncbi.nlm.nih.gov/pmc/articl...

[sumeet_shah Administrator]

Shweta11, please do not bother much about Ki67. It is mainly to help Oncologist take certain decisions. Like Kaare has said above, there are some who divide it into <15, 15 to 30 and above 30; and there are some who divide into < 10, 10 to 20 and above 20. Also, standardisation is important, which is lacking in many labs in India.

Ki 67 is just ONE of the factors considered; just seeing this one factor 'alone' does not make sense, one has to see the report as a whole, consider all the ten or fifteen factors and for that, the best person to guide you in neither me nor Kaare but your own Oncologist. Sit with your Oncologist and discuss in details. And don't worry, all will soon be fine.

[Shweta11]

Sumeet,

My oncologist is not very forthcoming with the questions I have, as he tells me not to worry and leave things to him

Thanks