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,P<0.001)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-67>50%)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,P<0.001;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,P<0.001。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,P<0.001)、肿瘤大小(χ~2=140.260,P<0.001)、腋窝淋巴结状态(χ~2=120.467,P<0.001)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,P<0.001)、肿瘤大小(χ~2=299.718,P<0.001)、腋窝淋巴结状态(χ~2=68.794,P<0.001)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.
OBJECTIVE Ki-67 is an antigen which associated with cell proliferation. In breast cancer,Ki-67 index is an important biological index to distinguish the type of luminal A and luminal B,and high Ki-67 index often indicates poor prognosis. However,the prognostic value of Ki-67 in triple negative breast cancer （TNBC） is not clear yet. The aim of our study was to analyze the prognostic value of Ki-67 in TNBC. METHODS From Jan 6th. 2009 to Dec. 30th,2010,to tally 310 TNBC patients were diagnosed in Affiliated Cancer Hospital of Zhengzhou University. We analyzed the impact factors on prognosis such as Ki-67 expression,et al. Using SPSS 17.0 software,numeration data were compared by using the chi-square test. Ki-67 diagnostic value and cutoff value were analyzed by ROC curve. Survival analysis was performed by Kaplan-Meier and Log-rank test was performed. Multivariate analysis was performed by Cox proportional hazards model. RESULTS After a median follow-up time of 65 months （3-81 months） ,68 patients （21.9%） has replaced and 48 patients （15.5 %） died of breast cancer. Clinicopathological factors such as menstruation （χ2= 8. 484, P = 0. 014）,tumor size （χ2 = 17. 580, P = 0. 007）, axillary lymph node status （χ2 = 30. 071, P〈 0. 001） and histological grade （χ2= 17.626, P = 0.001 ） were related with Ki-67 expression. The 5-year disease-free Survival （DFS） rate of low （〈 20 % ）, me- dium （20%-50%）,high Ki-67 group （〉50%） were 96.5% ,87.3%,64.9%（P〈0. 001） respectively. The 5-year over- all survival （OS） rate were 96.5% ,90.2% and 75.5% respectively （P〈0. 001）. The area under the ROC curve of DFS and OS in TNBC with Ki-67 was 0. 707 and 0. 689 ,and the best cut-off value was 57.5%. For univariate analysis,the fac- tors of DFS in TNBC are Ki-67（χ2 =31. 779,P〈0. 001） ,tumor size （χ2 =140. 260,P〈0. 001） ,axillary lymph node sta- tus （χ2 =120. 467,P%0. 001）and histological grade （χ2 =8. 765 ,P=0. 012） ,the factors of OS in TNBC were
作者
赵冰
焦得闯
乔江华
卢振铎
刘真真
ZHAO Bing JIAO De-chuang QIAO Jiang-hua LU Zhen-duo LIU Zhen-zhen(Department of Breast Surgery ,Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008 ,P. R. Chin)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2017年第13期888-893,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
三阴性乳腺癌
KI-67
截断值
预后
triple negative breast cancer
Ki-67
cut-off value
prognosis
