Ki-67表达水平及4种分子分型对髓母细胞瘤预后危险分级的价值  

Values of Ki-67 expression level and 4 molecular types for risk classification of prognosis in medulloblastoma

作　　者：李亚明[1] 李克[1] 张振宇[1] 张智峰[1] 刘霞[2] Li Yaming;Li Ke;Zhang Zhenyu;Zhang Zhifeng;Liu Xia(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pathology,the First People's Hospital of Xuzhou,Xuzhou 221600,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052 [2]徐州市第一人民医院病理科,徐州221600

出　　处：《肿瘤研究与临床》2022年第7期511-516,共6页Cancer Research and Clinic

基　　金：徐州市卫生健康委员会临床技术骨干研修计划(2020GG007)。

摘　　要：目的探讨Ki-67表达水平及4种分子分型对髓母细胞瘤(MB)患者预后危险分级的价值。方法回顾性研究2009年1月至2018年1月在郑州大学第一附属医院手术且术后病理诊断为MB患者92例,收集、整理患者临床资料和生存资料。采用Kaplan-Meier法分析总生存(OS)及无进展生存(PFS),并行log-rank检验;将Ki-67表达水平和分子分型相结合,对患者进行预后危险分级:低危组为Ki-67阳性指数≤50%且WNT或SHH亚型;中危组为Ki-67阳性指数≤50%且GROUP 3或GROUP 4亚型,或Ki-67阳性指数>50%且WNT或SHH亚型;高危组为Ki-67阳性指数>50%且GROUP 3或GROUP 4亚型。比较各危险组间OS和PFS差异。采用多因素Cox比例风险模型评估影响患者生存的因素。结果Ki-67阳性指数≤50%和>50%分别有50例(54.3%)、42例(45.7%),Ki-67阳性指数≤50%患者5年PFS率及OS率分别为46.9%和63.1%,Ki-67阳性指数>50%患者分别为28.5%和32.0%,两组间PFS和OS差异均有统计学意义(P值分别为0.020、0.028)。WNT、SHH、GROUP 3和GROUP 4亚型分别有16例(17.4%)、14例(15.2%)、40例(43.5%)和22例(23.9%),5年PFS率分别为78.0%、76.0%、19.2%、19.9%,5年OS率分别为82.1%、76.0%、40.2%、0;GROUP 3和GROUP 4亚型MB患者PFS和OS较WNT和SHH患者差(P值分别为0.003、0.039)。Ki-67表达水平和分子分型相结合进行预后危险分级,其中低危组12例(13.0%),中危组56例(60.9%),高危组24例(26.1%)。低、中、高危组MB患者PFS和OS差异均有统计学意义(均P<0.001)。多因素Cox回归分析显示,放疗、预后危险分级中危和低危为PFS独立保护因素(放疗比未放疗:OR=0.263,95%CI 0.124~0.556,P<0.001;中危组比高危组:OR=0.069,95%CI 0.008~0.581,P=0.014;低危组比高危组:OR=0.260,95%CI 0.131~0.514,P<0.001),放疗、预后危险分级低危为OS独立保护因素(放疗比未放疗:OR=0.221,95%CI 0.097~0.503,P<0.001;低危组比高危组:OR=0.328,95%CI 0.150~0.717,P=0.005)。结论Ki-67表达水平及4种分子分型与MB患者的预后Objective To investigate the values of Ki-67 expression level and 4 molecular types for risk classification of prognosis in patients with medulloblastoma(MB).Methods A retrospective study of 92 MB patients who underwent surgery and were confirmed by postoperative pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to January 2018 was performed.The clinical data and survival data of the patients were collected and sorted out.The overall survival(OS)and progression-free survival(PFS)were analyzed by Kaplan-Meier method,and the log-rank test was performed.Risk stratification of prognosis of patients was performed according to the Ki-67 expression level combined with molecular typing,the low-risk group had Ki-67 positive index≤50%and WNT or SHH subtype,the medium-risk group had Ki-67 positive index≤50%and GROUP 3 or GROUP 4 subtype,or Ki-67 positive index>50%and WNT or SHH subtype),and the high-risk group had Ki-67 positive index>50%and GROUP 3 or GROUP 4 subtype.The differences in OS and PFS among different risk groups were compared.A multivariate Cox proportional hazards model was used to assess factors affecting the survival of patients.Results There were 50 cases(54.3%)with Ki-67 positive index≤50%and 42 cases(45.7%)with Ki-67 positive index>50%.The 5-year PFS rate and OS rate of patients with Ki-67 positive index≤50%were 46.9%and 63.1%,and patients with Ki-67 positive index>50%were 28.5%and 32.0%,there were statistical differences in PFS and OS between the two groups(P values were 0.020 and 0.028).There were 16 cases(17.4%)of WNT subtype,14 cases(15.2%)of SHH subtype,40 cases(43.5%)of GROUP 3 subtype and 22 cases(23.9%)of GROUP 4 subtype,their 5-year PFS rates were 78.0%,76.0%,19.2%and 19.9%,respectively,and their 5-year OS rates were 82.1%,76.0%,40.2%and 0,respectively.MB patients with GROUP 3 or GROUP 4 subtype had poorer PFS and OS than patients with WNT or SHH subtype(P values were 0.003 and 0.039).Ki-67 expression level and molecular typing were combined to carry out

关 键 词：髓母细胞瘤 KI-67抗原 基因表达谱 预后 

分 类 号：R739.4[医药卫生—肿瘤]