三阴性乳腺癌组织Ki-67指数预后价值分析

发布时间：2018-07-29 14:42

【摘要】：目的 Ki-67是细胞增殖的相关抗原,Ki-67指数是区分乳腺癌Luminal A型和Luminal B型的重要生物学指标,高Ki-67指数往往预示着不良的预后。然而在三阴性乳腺癌(triple negative breast cancer,TNBC)中,Ki-67预后价值尚不明确。本研究旨在探讨TNBC中Ki-67指数的预后价值。方法回顾性分析郑州大学附属肿瘤医院2009-01-06-2010-12-30收治的310例经病理确诊为TNBC并有完整资料和随访数据患者的临床及病理资料,分析Ki-67指数等指标对患者生存预后影响。利用SPSS 17.0软件,计数资料比较采用χ~2检验。Ki-67诊断价值及截断值采用ROC曲线进行分析。生存分析采用Kaplan-Meier法,并进行Log-rank检验。多因素分析采用Cox比例风险模型。结果中位随访时间65个月(3~81个月),310例乳腺癌患者中复发68例(21.9%),死亡49例(15.8%),其中48例死于乳腺癌(15.5%)。Ki-67指数与患者月经状态(χ~2=8.484,P=0.014)、肿瘤大小(χ~2=17.580,P=0.007)、腋窝淋巴结状态(χ~2=30.071,P0.001)以及组织学分级(χ~2=17.626,P=0.001)均相关。低(Ki-67≤20%)、中(20%Ki-67≤50%)、高Ki-67组(Ki-6750%)5年无病生存率(disease-free survival,DFS)分别为96.5%、87.3%和64.9%,差异有统计学意义,P0.001;5年总生存率(overall survival,OS)分别为96.5%、90.2%和75.5%,差异有统计学意义,P0.001。Ki-67评价TNBC患者DFS及OS的ROC曲线下面积分别为0.707和0.689,Ki-67评价预后最佳截断值为57.5%。单因素分析中,Ki-67指数(χ~2=31.779,P0.001)、肿瘤大小(χ~2=140.260,P0.001)、腋窝淋巴结状态(χ~2=120.467,P0.001)和组织学分级(χ~2=8.765,P=0.012)是影响TNBC患者DFS的相关因素,Ki-67指数(χ~2=18.218,P0.001)、肿瘤大小(χ~2=299.718,P0.001)、腋窝淋巴结状态(χ~2=68.794,P0.001)和组织学分级(χ~2=7.572,P=0.023)是影响TNBC患者OS的相关因素;多因素分析中,Ki-67指数(HR=2.074,95%CI:1.279~3.364,P=0.003)、肿瘤大小(RR=1.879,95%CI:1.152~3.062,P=0.011)和腋窝淋巴结状态(RR=2.345,95%CI:1.825~3.015,P0.001)是影响患者DFS的独立因素,Ki-67指数(RR=1.752,95%CI:1.020~3.008,P=0.042)、肿瘤大小(RR=20.011,95%CI:1.132~3.574,P=0.017)和腋窝淋巴结状态(RR=2.021,95%CI:1.517~2.693,P0.001)是影响患者OS的独立因素。结论 Ki-67指数与TNBC患者预后相关,高Ki-67指数患者预后不良,Ki-67指数有望成为判断TNBC患者预后的一项重要生物学指标。
[Abstract]:Objective Ki-67 is the antigen associated with cell proliferation and Ki-67 index is an important biological index to distinguish Luminal A type from Luminal B type in breast cancer. High Ki-67 index often predicts poor prognosis. However, the prognostic value of Ki-67 in triple negative breast cancer (triple negative breast cancer-TNBC) remains unclear. The purpose of this study was to investigate the prognostic value of Ki-67 index in TNBC. Methods the clinical and pathological data of 310 patients with TNBC diagnosed pathologically in the affiliated Cancer Hospital of Zhengzhou University 2009-01-06-2010-12-30 were analyzed retrospectively. The influence of Ki-67 index on the survival and prognosis of the patients was analyzed. The diagnostic value of Ki-67 and the truncation value were analyzed by ROC curve and 蠂 ~ 2 test by using SPSS 17.0 software. Kaplan-Meier method and Log-rank test were used for survival analysis. Cox proportional risk model was used in multivariate analysis. Results the median follow-up time was 65 months (3 ~ 81 months). 68 cases (21.9%) had recurrence and 49 cases (15.8%) died of breast cancer. Among them, 48 cases died from breast cancer (15.5%). Ki-67 index was correlated with menstrual status (蠂 ~ 2J ~ (2.48 4) P ~ (0.014), tumor size (蠂 ~ (217.580) P _ (0.007), axillary lymph node status (蠂 ~ (22) 30.071 P _ 0.001) and histological grade (蠂 ~ (2) ~ (17.626) P ~ (0.001). Low (Ki-67 鈮，

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