Ki-67 is a valuable prognostic predictor of lymphoma but its utility varies in lymphoma subtypes: evidence from a systematic meta-analysis.
Ki-67 is a valuable prognostic predictor of lymphoma but its utility varies in lymphoma subtypes: evidence from a systematic meta-analysis.
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Ki-67 是淋巴瘤的一个有价值的预后预测因子，但其效用因淋巴瘤亚型而异：来自系统荟萃分析的证据
DOI：
10.1186/1471-2407-14-153
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发表时间：
2014-03-05
期刊：
影响因子：
3.8
通讯作者：
Huang L
中科院分区：
文献类型：
--
作者：
He X;Chen Z;Fu T;Jin X;Yu T;Liang Y;Zhao X;Huang L
Ki-67是一种参与细胞增殖调控的核蛋白，其表达已被广泛用作评价淋巴瘤增殖活性的指标。然而，它的淋巴瘤的预后价值仍然是矛盾的和inconclusion.MethodsPubMed和Web的科学数据库中搜索相同的策略。评估Ki-67表达对淋巴瘤和各种亚型淋巴瘤生存率的影响。在引入CD-20单克隆抗体利妥昔单抗后，还研究了Ki-67表达与弥漫性大B细胞淋巴瘤（DLBCL）和套细胞淋巴瘤（MCL）之间的关系。此外，我们评估Ki-67表达和淋巴瘤的临床病理特征之间的关联。ResultsA共27项研究符合纳入标准，其中包括3902例患者。Meta分析显示Ki-67高表达与淋巴瘤患者的无病生存期（DFS）（HR = 1.727，95%CI：1.159-2.571）和总生存期（OS）（HR = 1.7，95%CI：1.44 ~ 2）呈负相关。对不同亚型淋巴瘤的亚组分析表明，Ki-67高表达与霍奇金淋巴瘤的OS相关，（HR = 1.511，95%CI：0.524-4.358），而Ki-67高表达与非霍奇金淋巴瘤的OS较差高度相关。（HR = 1.777，95% CI：1.463-2.159）及其各种亚型，包括NK/T淋巴瘤（HR = 4.766，95%CI：1.917-11.849）、DLBCL（HR = 1.457，95%CI：1.123-1.891）和MCL（HR = 2.48，95%CI：1.61-3.81）。此外，MCL的合并HR为1.981利妥昔单抗组（95% CI：1.099-3.569）和3.123（95% CI：2.049-4.76），而对于DLBCL，DLBCL联合和不联合利妥昔单抗的合并HR为1.459（95% CI：1.084-2.062）和1.456（95% CI：0.951-2.23）。此外，Ki-67高表达与淋巴瘤的临床病理特征（包括LDH水平、B症状、肿瘤分期、淋巴结部位、体力状态和IPI评分）之间无相关性。结论本研究表明，Ki-67表达在不同亚型淋巴瘤中以及在利妥昔单抗治疗后DLBCL和MCL中的预后意义不同。对临床决策和个体预后评估有参考价值。
BackgroundKi-67 is a nuclear protein involved in cell proliferation regulation, and its expression has been widely used as an index to evaluate the proliferative activity of lymphoma. However, its prognostic value for lymphoma is still contradictory and inconclusive.MethodsPubMed and Web of Science databases were searched with identical strategies. The impact of Ki-67 expression on survival with lymphoma and various subtypes of lymphoma was evaluated. The relationship between Ki-67 expression and Diffuse Large B Cell Lymphoma (DLBCL) and Mantle Cell Lymphoma (MCL) was also investigated after the introduction of a CD-20 monoclonal antibody rituximab. Furthermore, we evaluated the association between Ki-67 expression and the clinical-pathological features of lymphoma.ResultsA total of 27 studies met the inclusion criteria, which comprised 3902 patients. Meta-analysis suggested that high Ki-67 expression was negatively associated with disease free survival (DFS) (HR = 1.727, 95% CI: 1.159-2.571) and overall survival (OS) (HR = 1.7, 95% CI: 1.44-2) for lymphoma patients. Subgroup analysis on the different subtypes of lymphoma suggested that the association between high Ki-67 expression and OS in Hodgkin Lymphoma (HR = 1.511, 95% CI: 0.524-4.358) was absent, while high Ki-67 expression was highly associated with worse OS for Non-Hodgkin Lymphoma (HR = 1.777, 95% CI: 1.463-2.159) and its various subtypes, including NK/T lymphoma (HR = 4.766, 95% CI: 1.917-11.849), DLBCL (HR = 1.457, 95% CI: 1.123-1.891) and MCL (HR = 2.48, 95% CI: 1.61-3.81). Furthermore, the pooled HRs for MCL was 1.981 (95% CI: 1.099-3.569) with rituximab and 3.123 (95% CI: 2.049-4.76) without rituximab, while for DLBCL, the combined HRs for DLBCL with and without rituximab was 1.459 (95% CI: 1.084-2.062) and 1.456 (95% CI: 0.951-2.23) respectively. In addition, there was no correlation between high Ki-67 expression and the clinical-pathological features of lymphoma including the LDH level, B symptoms, tumor stage, extranodal site, performance status and IPI score.ConclusionsThis study showed that the prognostic significance of Ki-67 expression varied in different subtypes of lymphoma and in DLBCL and MCL after the introduction of rituximab, which was valuable for clinical decision-making and individual prognostic evaluation.
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