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Background  This study evaluated the distribution pattern of the Ki67-labeling index (LI) among patients at a Chinese breast cancer center, and analyzed its prognostic significance in the 2015 St Gallen consensus breast cancer classification, estrogen receptor-positive and human epidermal growth factor receptor 2-negative(ER + /HER2 − )subtype.    Methods  We classified 939 women with ER + /HER2 −  breast cancer into three groups by Ki67-LI levels, and followed their clinicopathologic characteristics and prognoses.    Results  In the 939 eligible subjects, 342 had Ki67-LI ≤10% (Ki67 Low ), 281 had Ki67-LI between 10 and 30% (Ki67 Medium ), and 316 had Ki67-LI ≥30% (Ki67 High ). Although the Ki67 High  group had less favorable clinicopathologic factors, the Ki67 Medium  group’s factors varied considerably. Kaplan-Meier estimates showed that disease-free survival(DFS) for the Ki67 Medium  group was significantly shorter than the Ki67 Low  group but longer than the Ki67 High  group. Ki67-LI had independent prognostic significance in multivariate analysis. Other diagnostic factors, including tumor size >2 cm, positive lymph nodes, and grade III disease, were significantly associated with poorer disease-free survival only in the Ki67 Medium  group.    Conclusions  For patients with ER + /HER2 −  breast cancer, we confirmed three distinct risk patterns by Ki67-LI levels according to the 2015 St Gallen consensus. For patients with clearly low or high Ki67-LI, straightforward clinical decisions could be offered, but for patients with intermediate Ki67-LI, other factors might provide valuable information.    Electronic supplementary material  The online version of this article (doi:10.1186/s12885-016-3021-7) contains supplementary material, which is available to authorized users.

Prognostic significance of Ki67 in Chinese women diagnosed with ER+/HER2− breast cancers by the 2015 St. Gallen consensus classification