Prognostic impact of Ki-67 proliferative index in resectable pancreatic ductal adenocarcinoma
Prognostic impact of Ki-67 proliferative index in resectable pancreatic ductal adenocarcinoma
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DOI：
10.1002/bjs5.50175
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发表时间：
2019-10-01
期刊：
影响因子：
3.1
通讯作者：
Falconi, M.
中科院分区：
文献类型：
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作者：
Pergolini, I;Crippa, S.;Falconi, M.
背景胰腺导管腺癌（Pancreatic ductal adenocarcinoma，PDAC）是一种侵袭性疾病，生物学特征复杂，预后差。PDAC的预后分层将有助于改善患者管理。本研究的目的是分析Ki-67的表达与预后的PDAC患者进行手术治疗的队列。方法回顾性分析了2010年8月至2014年10月期间在两个意大利中心因PDAC接受胰腺切除术的患者。排除了转移性或局部晚期疾病患者、接受新辅助化疗的患者、导管内乳头状黏液性肿瘤引起的PDAC患者和数据缺失的患者。检索并分析临床和病理学数据。Ki-67表达采用免疫组化评价，患者分为三个亚组。根据Ki-67表达和肿瘤分级，对无病（DFS）和疾病特异性（DSS）生存结局进行生存分析。结果170例患者符合入选标准。Ki-67表达10%或更低、11- 50%和超过50%与DFS和DSS结局显著相关（分别为P = 0中心点016和P = 0中心点002）。Ki-67指数是DFS不良的独立预测因子（风险比（HR）0中心点52，95%置信区间）。0中心点29至0中心点91; P = 0中心点022）和DSS（HR 0中心点53，0中心点31至0中心点91; P = 0中心点022）。此外，Ki-67指数与肿瘤分级密切相关（P < 0，中心点001）。与其他患者相比，Ki-67指数高于50%的被归类为G3肿瘤的PDAC患者的生存结局较差（DFS和DSS的P < 0中心点001）。结论Ki-67指数可作为PDAC患者生存期的预测指标。需要在更大的队列中进行进一步研究以验证这些结果。
Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease characterized by complex biological features and poor prognosis. A prognostic stratification of PDAC would help to improve patient management. The aim of this study was to analyse the expression of Ki-67 in relation to prognosis in a cohort of patients with PDAC who had surgical treatment. Methods Patients who had pancreatic resection between August 2010 and October 2014 for PDAC at two Italian centres were reviewed retrospectively. Patients with metastatic or locally advanced disease, those who received neoadjuvant chemotherapy, patients with PDAC arising from intraductal papillary mucinous neoplasm and those with missing data were excluded. Clinical and pathological data were retrieved and analysed. Ki-67 expression was evaluated using immunohistochemistry and patients were stratified into three subgroups. Survival analyses were performed for disease-free (DFS) and disease-specific (DSS) survival outcomes according to Ki-67 expression and tumour grading. Results A total of 170 patients met the selection criteria. Ki-67 expression of 10 per cent or less, 11-50 per cent and more than 50 per cent significantly correlated with DFS and DSS outcomes (P = 0 center dot 016 and P = 0 center dot 002 respectively). Ki-67 index was an independent predictor of poor DFS (hazard ratio (HR) 0 center dot 52, 95 per cent c.i. 0 center dot 29 to 0 center dot 91; P = 0 center dot 022) and DSS (HR 0 center dot 53, 0 center dot 31 to 0 center dot 91; P = 0 center dot 022). Moreover, Ki-67 index correlated strongly with tumour grade (P < 0 center dot 001). Patients with PDAC classified as a G3 tumour with a Ki-67 index above 50 per cent had poor survival outcomes compared with other patients (P < 0 center dot 001 for both DFS and DSS). Conclusion Ki-67 index could be of use in predicting the survival of patients with PDAC. Further investigation in larger cohorts is needed to validate these results.