肿瘤组织Ki67的表达与肝细胞癌肝移植患者预后的关系

Association of the expression of Ki67 with the prognosis of liver transplantation in patients with hepatocellular carcinoma

目的探讨肝细胞癌(HCC)组织中Ki67的表达与肝移植(LT)患者预后的关系。方法收集178例接受原位肝移植治疗的HCC患者的临床资料和免疫组化结果,按照患者肿瘤组织Ki67表达水平的中位数将患者分为Ki67高表达组和低表达组。比较2组患者的临床指标。采用Kaplan-Meier法绘制生存曲线,比较2组患者的预后情况。采用单因素和多因素Cox回归分析影响患者LT术后预后的危险因素。结果178例研究对象中,Ki67高表达组85例,低表达组93例。Ki67高表达组患者术后1、3、5年总体生存率(78.7%、52.6%、39.5%)与无复发生存率(47.9%、34.7%、32.0%)明显低于Ki67低表达组(86.5%、76.3%、76.3%;84.4%、77.5%、72.4%,Log-rankχ^(2)分别为9.016和28.467,P<0.01)。Cox多因素分析显示Ki67高表达是影响患者术后无复发生存的独立危险因素(HR=3.653,95%CI:1.997~6.683,均P<0.01)。Ki67高表达患者术前血清甲胎蛋白水平、微血管侵犯以及肿瘤低分化的发生率高于低表达组(P<0.05)。结论HCC组织中Ki67的表达与患者LT术后的预后有关,Ki67可作为预测肝细胞癌肝移植患者预后的一个潜在指标。

Objective To explore the relationship between the expression of Ki67 in hepatocellular carcinoma(HCC)tissues and the prognosis of liver transplantation(LT)in patients with HCC.Methods The clinical data and results of immunohistochemical staining of 178 patients with HCC who underwent orthotopic liver transplantation between July 2014 and June 2018 were collected.According to the median expression level of Ki67 in tumor tissues,patients were divided into the Ki67 high expression group and the Ki67 low expression group.The clinical parameters were compared between the two groups.Kaplan-Meier methods was used to plot survival curves to compare the prognosis of the two groups of patients.Univariate and multivariate Cox regression were used to analyze risk factors affecting the prognosis of patients after LT.Results Among the 178 patients in this study,85 were in the Ki67 high expression group and 93 were in the Ki67 low expression group.The overall survival(78.7%,52.6%,39.5%)and recurrence-free survival(47.9%,34.7%,32.0%)were significantly lower in patients in the Ki67 high expression group than those in the Ki67 low expression group(86.5%,76.3%,76.3%;84.4%,77.5%,72.4%),Log-rankχ^(2) were 9.016 and 28.467,respectively(P<0.01).Cox multivariate analysis showed that the high expression of Ki67 was an independent risk factor affecting recurrence-free survival(HR=3.653,95%CI:1.997-6.683,P<0.01).The incidence of microvascular invasion,poor tumor differentiation and preoperative serum alphafetoprotein level were higher in the Ki67 high expression group than those in the Ki67 low expression group(P<0.05).Conclusion The expression of Ki67 is related to the prognosis of HCC patients after LT.Ki67 can be used as a potential indicator to predict the prognosis of HCC patients after LT.