Ki-67 : rôle dans le diagnostic, le pronostic et le suivi après traitement des cancers du sein
Mots-clés :
Cancer, sein, histologie, immunohistochimie, Ki 67, expression, taux, pronostic, indications, chimiothérapie, adjuvante, néoadjuvante, hormonothérapieRésumé
RESUME
Buts : Evaluer les données de la littérature concernant l’intérêt diagnostique, pronostique et le rôle dans l’évaluation de la réponse au traitement du Ki-67 dans les cancers du sein(CS).
Méthodes : Une revue systématique a été réalisée en se référant au moteur de recherche de la National Library of Medicine (PubMed) entre janvier 2015 et mars 2015 en utilisant les mots clés: Breast cancer , Ki-67 , prognosis , proliferation , chemotherapy, adjuvant, neoadjuvant, hormonotherapy
Résultats : Le Ki-67, évalué par immunohistochimie (IHC), est utilisé en routine comme marqueur de l'activité proliférative des CS pour la classification immunohistochimique, essentiellement pour différencier les luminaux A et B avec un cut-off de 14%, intervenant dans les indications ou non de la chimiothérapie adjuvante. Il a également un rôle dans l’évaluation de la réponse aux thérapies médicales néoadjuvantes par chimio, hormonothérapie et ou thérapie ciblée. Une expression élevée du Ki-67 supérieure à 20%, plus fréquente en cas de CS her 2 + ou triple négatif, traduit un moins bon pronostic mais également un taux de réponse compléte clinique/histologique (pCR) plus élevé après chimiothérapie
Conclusion: L’évaluation IHC du taux de Ki-67 reste pratiquée dans les pays sans plateformes bimoléculaires et aide aux indications de traitements médicaux adjuvants et néoadjuvants, bien qu’elle souffre d’insuffisances techniques.
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