垂体腺瘤Ki67抗原表达与近期手术疗效的相关性研究

Correlation of Ki67 antigen expression with surgical therapeutic effect in invasive and non-invasive pituitary adenomas

目的 探讨细胞增殖指数Ki67在侵袭性、非侵袭性垂体腺瘤中的表达差异及其对近期手术疗效的预测价值。方法 回顾性分析北京协和医院神经外科收治的58例垂体腺瘤的临床资料，采用免疫组织化学方法检测Ki67抗原表达，磁共振评估采用Knosp分级，0～Ⅱ级为非侵袭性，Ⅲ～Ⅳ级为侵袭性。术后6个月后复查蝶鞍增强磁共振扫描（magnetic resonance imaging，MRI），未见肿瘤残留为影像学治愈；功能型垂体腺瘤同时复查相应激素，术后6个月后下降至正常范围为内分泌治愈。采用统计学方法分析Ki67与MRI影像学分级、近期手术疗效相关性。结果 MRI冠状位增强显示的非侵袭组（n=15）和侵袭组（n=43）Ki67阳性指数中位数均为1．0％，2组间差异无统计学意义（P=0．610）；激素分泌型（n=38）和无功能型（n=20）垂体腺瘤Ki67阳性指数中位数均为1．0％，2组间差异无统计学意义（P=0．308）；术后6个月影像学治愈组和残留组Ki67阳性指数中位数均为1．0％，2组间差异无统计学意义（P=0．495）；功能型垂体腺瘤患者中，内分泌治愈组和未愈组Ki67阳性指数中位数分别是1．0％和1．5％，2组间差异无统计学意义（P=0．343）。本组平均随访13．1（6～18）个月。结论 Ki67表达水平与术前MRI所示侵袭性及近期手术疗效无明显相关性。

Objective To investigate the different expression of Ki67 in invasive and non-invasive pituitary adenoma, and its value in prediction of surgical therapeutic effect. Methods Data of 58 cases of pituitary adenoma were retrospectively analyzed. The expression of Ki67 antigen was detected by immunohistochemical staining. Knosp grading assessed by magnetic resonance（MR）was divided into 2 grades：non-invasive group with 0 -Ⅱ level and invasive group with Ⅲ-Ⅳlevel. Radiological cure was defined as no residual tumor in the sella was found by enhanced MR at least 6 months after surgry. As for functional pituitary adenoma, endocrinological cure was defined as the corresponding declined to a normal level of specific hormone at least 6 months after surgery. The correlation of Ki67 expression with MRI-based grades and surgical therapeutic effects was analyzed by statistical method. Results The median Ki67-positive index accessed by enhanced MRI in coronal sections was both 1.0% in non-invasion group （ n = 15 ） and invasion group （ n = 43 ） , without significant differences （ P = 0. 610）. The median Ki67-positive index was both 1.0% in hormone-secreted group（n = 38）and nonfunetioning group （n =20 ）pituitary glands tumor, as well as in tumor-free group and tumor-residual group determined by MRI in 6 months after surgery, both without significant difference（ P = 0. 308 and 0. 495 respectively）. When considering endocrinologic therapeutic effect of functional pituitary adenoma, the average Ki67-positive index was 1.0% and 1.5% in the cured and uncured group, without significant differences（P = 0. 343）. The median follow-up was 13.1 months（ ranging from 6 to 18 months）. Conclusion There is no significant correlation between Ki67 expression and the invasive capacity showed by preoperative MRI as well as the surgical therapeutic effect in the near future.