Ki-67增殖指数在初治可切除胃癌预后中的价值

The value of Ki-67 proliferation index in the prognosis of newly treated resectable gastric cancer

目的研究Ki-67增殖指数与胃癌患者临床病理参数的关系,分析Ki-67增殖指数对患者预后的影响,对TNM分期系统进行补充,进一步对患者进行分层指导治疗。方法选取被确诊为胃癌的90例患者。利用免疫组织化学的方法对Ki-67增殖指数进行测定。利用生存分析研究Ki-67增殖指数及各临床病理参数与患者5年总体生存率的关系。并运用受试者工作特征(ROC)曲线评估3种模型对患者生存情况的预测能力。结果低分化胃癌组Ki-67增殖指数明显低于中高分化胃癌组,差异有统计学意义(P=0.008)。低分化、T3/T4分期、淋巴结转移阳性、病理分期Ⅱ/Ⅲ期患者的5年总体生存率明显低于中高分化、T1/T2分期、淋巴结转移阴性、病理分期Ⅰ期患者,差异均有统计学意义(P=0.012、0.013、0.008、0.006)。且Ki-67增殖指数小于30%的患者5年总体生存率明显低于Ki-67增殖指数大于或等于30%的患者,差异有统计学意义(P=0.003)。多因素Cox生存分析显示病理分期及Ki-67增殖指数是患者5年总体生存率的独立危险因素,差异有统计学意义(HR=5.114,P=0.026;HR=2.746,P=0.010)。Ki-67增殖指数联合病理分期及分化程度模型[ROC曲线下面积(AUC=0.778)]明显优于病理分期模型(AUC=0.636)和Ki-67增殖指数联合病理分期模型(AUC=0.716)对患者生存情况的预测能力。结论低Ki-67增殖指数是初治可切除胃癌患者预后较差的独立危险因素,Ki-67联合病理分期及分化程度对患者生存有较好的预测能力。

Objective To study the relationship between Ki-67 proliferation index and clinicopathological parameters of resectable gastric cancer patients,analyze the influence of Ki-67 proliferation index on the prognosis of patients,supplement the TNM staging system,and further stratify patients to guide treatment.Methods Ninety patients diagnosed with gastric cancer were selected.The Ki-67 proliferation index was determined by immunohistochemistry.Survival analysis was used to study the relationship between Ki-67 proliferation index and various clinicopathological parameters and the 5-year overall survival rate of patients.The receiver operating characteristic(ROC)curve was used to evaluate the predictive ability of the three models for patient survival.Results Ki-67 proliferation index in the low-differentiated gastric cancer group was significantly lower than that in the patients with medium-high differentiated gastric cancer,and the difference was statistically significant(P=0.008).The 5-year overall survival rate of patients with low differentiation,positive lymph node metastasis,or in T3/T4 stage,pathological stageⅡ/Ⅲwere significantly shorter than that of patients with middle-high differentiation,negative lymph node metastasis,or in T1/T2 stage,pathological stageⅠ,and the differences were statistically significant(P=0.012,0.013,0.008,and 0.006).The 5-year overall survival rate of patients with Ki-67 proliferation index less than 30%was significantly lower than that of patients with Ki-67 proliferation index greater than or equal to 30%,the difference was statistically significant(P=0.003).Multivariate Cox survival analysis showed that pathological stage and Ki-67 proliferation index were independent risk factors for the overall 5-year survival rate of patients,and the difference were statistically significant(HR=5.114,P=0.026;HR=2.746,P=0.010).Ki-67 proliferation index combined with pathological stage and differentiation degree model(AUC=0.778)was significantly better than the other two models[the pathological stage model(AUC=0.636),and the Ki-67 proliferation index combined with pathological stage model(AUC=0.716)]in predicting the survival of patients.Conclusion The low Ki-67 proliferation index is an independent risk factor for the poor prognosis in patients with newly treated resectable gastric cancer.Ki-67 proliferation index combined with pathological stage and degree of differentiation has a good predictive ability for patient survival.