Ki-67表达及MRI信号值与颅底脊索瘤术后复发的相关性

Research on relations among Ki-67,MRI grade and recurrence of skull base chordomas

目的探讨颅底脊索瘤Ki-67表达及MRI信号值与颅底脊索瘤复发的相关性。方法回顾性分析首都医科大学附属北京天坛医院神经外科经手术切除病理证实的28例颅底脊索瘤患者的临床资料。分析其Ki-67指数、MRI影像学特点,随访观察患者的预后,进行统计学分析。结果本组患者的Ki-67表达指数为1%~30%,平均值为7.6%±8.0%。其中,Ki-67指数<5%(K1组)、5%~15%(K2组)及>15%(K3组)的患者,分别为12例(42.9%)、12例(42.9%)和4例(14.3%)。脊索瘤与脑干的MRI信号值比值,Rt1、Rt2、Ren的范围分别为0.41~1.05、1.3~4.4、0.7~2.3。其中MRI分组组Ⅱ患者12例、组Ⅲ患者16例,无组Ⅰ的患者。Spearman相关分析显示,MRI信号值与Ki-67指数分组之间无相关关系(P=0.553)。患者术后平均随访(35.5±23.8)个月(3~86个月),其中复发患者19例(67.9%),平均复发时间(27.4±19.6)个月。相关分析显示,MRI信号值组Ⅲ患者的复发率明显高于组Ⅱ(P=0.012)。多因素生存分析显示,脊索瘤的Ki-67指数(P=0.004)和MRI信号值(P=0.013)是颅底脊索瘤术后复发的危险因素。结论颅底脊索瘤的Ki-67表达指数与MRI信号值是其术后复发的预测指标;并且均为独立危险因素。

Objective To evaluate the effect of Ki-67 and MRI grade on recurrence of skull base chordomas.Methods The clinical data of 28 patients with skull base chordoma confirmed by pathology underwent surgical resection at department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,were analyzed retrospectively.The immunohistochemistry study of Ki-67,MRI grade,as well as the clinical data were also analyzed and all the patients were followed-up.SPSS was used for statistical performance.Results There were 28 skull base chordomas included in the present study,the expression of Ki-67 varied from 1%-30%(fig 2),the mean expression rate was 7.6%±8.0%,there were 12(42.9%),12(42.9%),and 4(14.3%)in group K1,K2 and K3,respectively.MRI signal rate of the tumor to brainstem on T1,T2 and Ten were(0.41-1.05),(1.3-4.4),(0.7-2.3)respectively,and there was no group 1 in the present series by MRI group,there was 12 cases in group 2 and 16 cases in group 3.The spearman relationship analysis showed no correlational relationship between the MRI signal grade and Ki-67 expression(P=0.553).With a mean follow up time of 35.5±23.8 months(3-86 months),there were 19 cases had recurrence(67.9%),with the mean recurrence time 27.4±19.6 months,MRI signal group 3 showed worse recurrence rate was than the group 2(P=0.012).The COX analysis showed the expression of Ki-67 index(P=0.004),MRI signal grade(P=0.013)was the risk factors for recurrence of the skull base chordomas.Conclusion The present series of limited case shows that the expression of Ki-67 index and MRI signal grade is the independent risk factors of recurrence.