Ki-67在卵巢癌中的表达差异及卵巢癌高危因素的研究

Difference in Ki-67 Expression among Different Ovarian Carcinomas and Their High Risk Factors

目的通过分析恶性卵巢癌之间Ki-67表达的差异和高危因素的研究,探讨其临床应用价值。方法 156例卵巢癌患者,按病理FIGO(2000年)分期法分类:浆液性乳头状癌81例,黏液性乳头状癌26例,子宫内膜样癌16例,透明细胞癌8例,恶性畸胎瘤5例,颗粒细胞瘤12例,未分化癌3例,无性细胞瘤5例。通过Cox模型筛选法,参数评估生存率的危险因素,并通过免疫组织化学法分析不同分期卵巢癌病例Ki-67表达的不同情况。结果化疗次数和孕次是保护因素(b=-0.175,RR=0.840;b=-0.189,RR=0.828);局部淋巴结转移、远处转移和盆腔浸润是危险因素(b=0.638,RR=1.893;b=1.929,RR=6.886;b=0.971,RR=2.640)。156例患者中85例患者进行Ki-67的免疫组织化学检测,其中18例患者Ki-67表达呈阴性(0级),21例患者Ki-67表达呈弱阳性(Ⅰ级),20例患者Ki-67表达呈强阳性(Ⅱ级),26例患者表达呈强阳性(Ⅲ级)。有无侵润及不同病理组织分类中Ki-67表达水平比较差异有统计学意义(P<0.05或P<0.01)。结论卵巢癌化疗次数和孕次是保护因素,而局部淋巴结转移、远处转移和盆腔浸润是危险因素。

Objective To investigate the clinical value of Ki-67 through analyzing the difference in Ki-67 expression among different ovarian carcinomas and their high risk factors. Methods According to the International Federation of Gynecology and Obstetrics（FIGO 2000） staging, 156 ovarian cancer patients were grouped as follows： serous papillary carcinoma（n=81）, papillary mucinous carcinoma（n=26）, endometrioid carcinoma（n=16）, clear cell carcinoma（n=8）, malignant teratoma（n=5）, granulosa cell tumor（n=12）, undifferentiated carcinoma（n=3）, and dysgerminoma（n=5）. Cox model screening method was used to parametrically estimate the risk factors for survival rate and immunohistochemistry was used to analyze the Ki-67 expression in different stages of ovarian cancer. Results The protective factors included the number of chemotherapy（b=-0.175, RR=0.840） and number of pregnancy（b=-0.189, RR=0.828）. The risk factors included regional lymph node metastasis（b=0.638, RR=1.893）, distant metastasis（b=1.929,RR=6.886） and pelvic infiltration（b=0.971, RR=2.640）. The expression of Ki-67 was assessed in 85 of the 156 patients. Among them, immunohistochemistry showed negative staining（grade 0） in 18,weakly positive staining（gradeⅠ） in 21, strongly positive staining（gradeⅡ） in 20, and ultra-strongly positive staining（grade Ⅲ） in 26.There were significant differences in the expression of Ki-67 were found among different pathological classification, as well as among different with or with out invasion types of ovarian cancer（P〈0.05 or P〈0.01）. Conclusion The number of chemotherapy and number of pregnancy are the protective factors for ovarian cancer, whereas regional lymph node metastasis, distant metastasis and pelvic infiltration are the risk factors for ovarian cancer.