Ki67与子宫内膜癌临床病理特点及预后的关系  

Relationship between Ki67 and clinicopathological characteristics and prognosis of endometrial cancer

作　　者：刘林枝[1] 范欣 冯宗昊 张岩[1] LIU Lin-zhi;FAN Xin;FENG Zong-hao;ZHANG Yan(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics and Gynecology,Nanping First Hospital of Fujian Medical University,Fujian Nanping 353000,China)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]福建医科大学附属南平市第一医院妇产科,福建南平353000

出　　处：《中国医刊》2019年第2期177-183,共7页Chinese Journal of Medicine

摘　　要：目的探讨子宫内膜癌中Ki67的表达与临床病理特点及预后的关系。方法收集2010年9月至2017年7月北京大学第一医院妇科收治的583例子宫内膜癌患者的病例资料,对其临床特点、组织病理及免疫组化结果、随访资料进行统计分析。结果非子宫内膜样癌、腹腔冲洗液阳性、淋巴脉管间隙浸润阳性的患者中,Ki67阳性率≥65%的患者比例显著增加(P<0.05)。Spearman相关分析显示,Ki67的表达与国际妇产科联盟(FIGO)分期、肌层浸润深度呈正相关(r=0.175,P=0.000;r=0.106,P=0.010),分期越高,肌层浸润深度越深,Ki67的表达水平越高;与组织分化程度呈负相关(r=-0.146,P=0.001),组织分化越差,Ki67表达水平越高;与雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor,PR)的表达呈负相关(r=-0.116,P=0.005;r=-0.168,P=0.000),与P53的表达呈正相关(r=0.195,P=0.000)。肿瘤直径、有无淋巴结转移、PTEN的表达与Ki67的表达水平无关(P>0.05)。单因素Kaplan-Meier分析结果显示,Ki67的表达水平与子宫内膜癌患者的术后5年生存率密切相关(P=0.001,HR=4.81,95%CI 1.96～11.83),且Ki67阳性率≥65%同时ER/PR阴性、P53阳性的子宫内膜癌患者预后最差(P=0.000,HR=18.23,95%CI 0.67～112.77)。多因素Cox比例风险回归分析结果显示,在排除年龄、组织病理类型、分化程度、肌层浸润深度、肿瘤直径、腹腔冲洗液、淋巴脉管间隙浸润、ER、PR、P53、PTEN等因素的作用后,Ki67阳性率以65%为界值并不是影响子宫内膜癌患者预后的独立风险因素(OR=0.70,95%CI 0.14～3.43,P=0.659)。结论 Ki67高表达与子宫内膜癌患者的不良临床病理特点密切相关。当Ki67阳性率≥65%时,子宫内膜癌患者预后不良。Objective To explore the relationship between Ki67 and clinicopathological characteristics and prognosis in endometrial cancer.Method The clinical data of 583 cases of endometrial cancer treated by Department of Gynecological of Peking University First Hospitalwere collected and their clinical characteristics,histopathology,immunohistochemical findings and follow-up data were statisticallyanalyzed.Result The proportion of patients with Ki67≥65% increased signi?cantly among patients with non-endometrioid carcinoma,positive peritoneal cytology,lymphovascular space invasion(LVSI)(P<0.05).Spearman correlation analysis showed that the expressionof Ki67 was negatively correlated with histologic grade(r=-0.146,P=0.001),the expression of ER(r=-0.116,P=0.005) and PR(r=-0.168,P=0.000),and positively correlated with the FIGO staging(r=0.175,P=0.000),depth of invasion(r=0.106,P=0.010)and the expression of P53(r=0.195,P=0.000).There were no signi?cant relationships between tumor size,lymph node metastasis,theexpression of PTEN and Ki67(P>0.05).Univariate Kaplan-Meier analysis showed that the expression of Ki67 was closely related to the5-year survival rate of patients with endometrial cancer(P=0.001,HR=4.81,95%CI 1.96-11.83) and patients with Ki67≥65%,ER/PR(-) and P53(+) had the poorest prognosis(P=0.000,HR=18.23,95%CI 0.67-112.77).The results of multivariate Cox proportionalhazards regression analysis showed that Ki67 was not an independent risk factor for the prognosis of patients with endometrial cancer(OR=0.70,95%CI 0.14-3.43,P=0.659) after adjusting the age,histopathological types,histologic grade,depth of invasion,tumor size,peritoneal cytology,LVSI,ER,PR,P53,PTEN.Conclusion The higher expression of Ki67 was closely related to poor clinicopathologicalcharacteristics in endometrial cancer and Ki67≥65% prompted poor prognosis in patients with endometrial cancer.

关 键 词：子宫内膜癌 KI67 临床病理特点 预后 

分 类 号：R737.33[医药卫生—肿瘤]