Ki-67增殖指数在评估甲状腺髓样癌淋巴结转移及预后中的临床价值

Clinical value of Ki-67 in the evaluation of lymph node metastasis and prognosis of medullary thyroid carcinoma

目的探讨Ki-67增殖指数在评估甲状腺髓样癌(medullary thyroid carcinoma,MTC)淋巴结转移及预后中的临床价值。方法回顾性收集2012年1月~2021年9月在浙江省肿瘤医院初治并手术的86例MTC患者,采用免疫组化技术检测MTC组织中Ki-67增殖指数,分析Ki-67增殖指数与MTC淋巴结转移的关系,并评价其在MTC预后判断中的意义。结果86例MTC中淋巴结转移51例(59.30%),单因素分析显示,Ki-67增殖指数与MTC病灶数目、病灶大小、腺外侵犯、淋巴结转移各参数、淋巴结结外侵犯以及TNM分期相关(P均<0.05),而与MTC患者的性别、年龄、被膜侵犯、脉管侵犯以及是否达到生化治愈无关(P均>0.05)。采用Logistic多因素回归分析(向前LR法)结果表明,淋巴结转移与Ki-67增殖指数密切相关(P=0.001)。本组患者随访6~169个月,中位随访时间55个月,出现复发或转移14例,死亡5例,5年无复发生存率为79.7%,5年总生存率为93.2%。采用Kaplan-Meie法分析生存数据显示,Ki-67增殖指数与MTC预后(复发转移、死亡)无显著相关(Log Rank P>0.05)。结论Ki-67增殖指数与MTC患者颈淋巴结转移密切相关,是预测MTC颈淋巴结转移的独立危险因素。

OBJECTIVE To investigate the clinical value of Ki-67 in the evaluation of lymph node metastasis and prognosis for medullary thyroid carcinoma.METHODS The clinical data of 86 patients with MTC initially treated and operated in Zhejiang Cancer Hospital from January 2012 to September 2021 were retrospectively studied.Ki-67 in MTC tissue was detected by immunohistochemical technique.The relationship between Ki-67 and lymph node metastasis of MTC was analyzed and its significance in the prognosis of MTC was also evaluated.RESULTS The rate of lymph node metastasis in MTC was 59.30%(51/86).Univariate analysis showed that Ki-67 was correlated with the number of MTC lesions,lesion size,extrathyroidal infiltration,lymph node metastasis,extranodal invasion and TNM stage(all P<0.05),but not with gender,age,capsular invasion,vascular invasion and biochemical cure of MTC patients(all P>0.05).Logistic multivariate regression analysis(forward LR method)showed that lymph node metastasis was closely related to Ki-67(P=0.001).In this group,MTC patients were followed up for 6-169 months(median follow-up time was 55 months),recurrence or metastasis occurred in14 cases,and 5 cases died.The five-year recurrent-free survival rate was 79.7%,and the five-year overall survival rate was 93.2%.Kaplan-Meier analysis of survival data showed that Ki-67 was not significantly correlated with MTC prognosis(recurrence,metastasis or death)(Log Rank P>0.05).CONCLUSION Ki-67 is closely related to cervical lymph node metastasis in MTC patients,and is an independent risk factor for predicting cervical lymph node metastasis of MTC.