晚期肺腺癌患者Ki-67表达水平与临床疗效的关系  

Ki-67 expression affects the clinical therapeutic effect on advanced lung adenocarcinoma

作　　者：熊焕文 夏国际 吴冠楠[2] XIONG Huan-wen;XIA Guo-ji;WU Guan-nan(Department of Respiratory Medicine,the 94th Hospital of Chinese PLA,Nanchang 330002,Jiangxi,China;Department of Respiratory and Critical Care Medicine,Nanjing General Hospital of Nanjing Military Region,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]解放军第九四医院呼吸内科,南昌医学硕士330002 [2]南京军区南京总医院呼吸与危重症医学科,南京210002

出　　处：《医学研究生学报》2018年第12期1281-1284,共4页Journal of Medical Postgraduates

基　　金：江西省自然科学基金(20161BAB205280)

摘　　要：目的 Ki-67作为非小细胞肺癌(NSCLC)预后差的标志,其与临床疗效的关系一直是研究热点。文中旨在探讨Ki-67表达水平与晚期肺腺癌治疗临床疗效之间的相关性。方法选取2015年1月至2015年12月南京军区南京总医院呼吸与危重症医学科92例肺腺癌患者。根据治疗不同分为靶向组[表皮生长因子受体(EGFR)阳性患者服用吉非替尼,间变性淋巴瘤激酶(ALK)阳性者服用克唑替尼,n=65]、化疗组(给予培美曲塞+顺铂或奈达铂,n=27)。免疫组化方法检测Ki-67,分为Ki67低表达者(n=43)和Ki67高表达者(n=49)。采用ALK、ARMS法测定EGFR,分析Ki-67蛋白表达与临床病理特征的关系,计算一线治疗的无进展生存期(PFS),通过生存分析观察Ki-67表达与临床疗效的关系。结果 Ki67低表达者一线治疗后中位PFS明显大于Ki67高表达者(10个月vs 7个月,P<0.05)。靶向组Ki-67低表达者、高表达者的中位PFS分别为10个月、7个月,差异有统计学意义(P<0.05);化疗组Ki-67低表达者、高表达者中位PFS分别为8个月、7个月,差异无统计学意义(P>0.05)。Ki-67(HR=1.011,95%CI:1.000～1.023)、ALK(HR=0.325,95%CI:0.112～0.942)是PFS的不良预测因子(P<0.05)。结论 Ki-67表达水平影响临床治疗疗效,特别是一线靶向治疗疗效,需要临床高度重视。Objective The expression level of the Ki-67 protein is a marker of the poor prognosis in non-small-cell lung cancer.This study explored the correlation of the Ki-67 expression level with the clinical efficacy in the treatment of advanced lung adenocarcinoma. Methods From January 2015 to December 2015,92 patients with stageⅣlung adenocarcinoma were treated in the Department of Respiratory and Critical Care Medicine of Nanjing General Hospital,65 with oral gefitinib for EGFR mutation-positive or crizotinib for ALK positive(the targeted therapy[TT]group)and the other 27 with pemetrexed+cisplatin or nedaplatin(the chemotherapy group).The expression of Ki-67 was determined by immunohistochemistry,its relationship with the clinicopathological features and therapeutic effects was analyzed,and the progression-free survival(PFS)was calculated. Results Ki-67 was expressed lowly in 43(46.7%)and highly in 49(53.3%)of the cases.The median PFS after treatment was significantly longer in the patients with a low than in those with a high Ki-67 expression in the TT group(10 vs 7 mo,P<0.05)and in the CT group as well(8 vs 7 mo,P<0.05).Ki-67(HR=1.011,95%CI:1.000-1.023)and ALK(HR=0.325,95%CI:0.112-0.942)were shown to be predictive factors of poor PFS. Conclusion The expression level of Ki-67 affects the effect of clinical treatment,especially that of the first-line targeted therapy,on advanced lung adenocarcinoma.

关 键 词：肺腺癌 KI-67 靶向治疗 疗效 

分 类 号：R734.2[医药卫生—肿瘤]