胃癌术后Ki-67核抗原表达与临床病理特征和预后关系的研究  

Association of Ki-67 nuclear antigen expression with clinicopathologic features and prognosis after surgery for gastric cancer

作　　者：潘晓华 司理想 孙灵 徐新宇[2] 李刚[3] 陆建伟[1] PAN Xiaohua;SI Lixiang;SUN Ling;XU Xinyu;Li Gang;LU Jianwei(Affiliated Cancer Hospital of Nanjing Medical University,Department of Medical Oncology,Jiangsu Cancer Hospital,Nanjing 210018,China)

机构地区：[1]南京医科大学附属肿瘤医院、江苏省肿瘤医院肿瘤内科,南京210018 [2]南京医科大学附属肿瘤医院江苏省肿瘤医院病理科,210018 [3]南京医科大学附属肿瘤医院江苏省肿瘤医院普外科,210018

出　　处：《临床肿瘤学杂志》2023年第2期145-150,共6页Chinese Clinical Oncology

摘　　要：目的 探讨Ki-67表达及与CEA联合检测和胃癌术后患者临床病理特征、预后的关系。方法 回顾性分析2015年1月至2016年12月于江苏省肿瘤医院行胃癌根治性手术患者的临床和随访资料,术前1周内行电化学发光法检测空腹血清CEA表达,术后肿瘤组织用免疫组织化学方法检测Ki-67表达。采用Pearson卡方检验分析Ki-67、CEA表达、临床病理特征的相关性,Kaplan-Meier分析方法、Log-rank检验、Cox回归模型分析Ki-67或联合CEA对预后的影响。结果 在798例胃癌术后病例中368例(46.1%)Ki-67高表达,Ki-67表达与患者年龄(P<0.001)、TNM分期(Ⅲvs.Ⅰ,P=0.036)、T分期(T4vs.T1~T3,P<0.001)、CEA表达有关(P=0.01),与N分期表达无关(P>0.05),CEA表达与临床分期(Ⅰ、Ⅱ、Ⅲ期)有关(P=0.003)。所有患者5年总生存率为68.4%,Cox回归模型分析提示年龄(P<0.001)、TNM分期(P<0.001)、Ki-67(P=0.040)、CEA(P=0.006)是影响胃癌术后生存的独立预后因素。Ⅲ期患者Ki-67低表达和CEA正常表达的5年生存率均高于高表达患者(59.8%vs. 48.9%,P=0.003、60.4%vs.43.8%,P=0.003),但在Ⅰ、Ⅱ期患者中未发现相关性。低危组(Ki-67低表达+CEA正常表达)、中危组(Ki-67或CEA任一指标高表达)、高危组(Ki-67高表达+CEA高表达)5年生存率有显著统计学差异(76.3%vs.66.7%vs. 55.1%,P<0.001)。在Ⅱ、Ⅲ期患者中,低危组5年生存率均高于中、高危组(78.4%vs. 79.1%vs. 61.4%,P=0.008、68.2%vs. 47.3%vs. 46.3%,P<0.001)。结论 Ki-67可能影响胃癌术后患者生存,联合检测Ki-67、CEA有助于提高Ⅱ、Ⅲ期胃癌术后患者预后预测作用。Objective To investigate the relationship between Ki-67 expression and the clinicopathologic features and prognosis of patients with carcinoembryonic antigen(CEA) and gastric cancer after surgery. Methods Retrospective analysis of clinical and follow-up data of patients who underwent radical gastrectomy for cancer at the Jiangsu Oncology Hospital between January 2015 and December 2016. The serum CEA expression was detected by electrochemiluminescence within 1 week before operation, the expression of Ki-67 was detected by immunohistochemistry. Correlation between Ki-67, CEA expression, and clinicopathologic characteristics was analyzed using the Pearson chi-square test. Kaplan-Meier analysis method, Log-rank test, and Cox regression model were used to analyze the prognostic impact of Ki-67 or combined CEA. Results Of 798 patients with postoperative gastric cancer, 368(46.1%) had Ki-67 high expression. Ki-67 expression was associated with age(P<0.01), TNM stage(Ⅲ vs. Ⅰ, P=0.036), T stage(T4vs. T1-T3, P<0.001) and CEA(P=0.01), but not N stage(P>0.05). CEA correlates with clinical stage(stage Ⅰ-Ⅲ, P=0.003). The 5-year overall survival(OS) rate for all patients was 68.4%. Cox regression analysis showed that age(P<0.001), TNM stage(P<0.001), Ki-67(P=0.04), and CEA(P=0.006) were independent predictors of survival after gastric cancer surgery. The 5-year OS rate of patients with stage Ⅲ with Ki-67-L and CEA-normal-expression(CEA-N) was higher than that of patients with high expression(59.8% vs. 48.9%,P=0.003;60.4% vs.43.8%,P=0.003), but no correlation was found in patients with stage Ⅰ and Ⅱ. Statistically significant differences in 5-year OS were observed between low-risk(Ki-67-L + CEA-N) group, intermediate-risk(Ki-67-H or CEA-H) group, and high-risk(Ki-67-H + CEA-H) groups(76.3% vs. 66.7% vs. 55.1%, P<0.001) group. In patients with stage Ⅱ and Ⅲ, the 5-year OS rate was higher in low-risk group than in the intermediate-risk or high-risk group(78.4% vs. 79.1% vs. 61.4%, P=0.008;68.2% vs. 47.3% vs. 46.3

关 键 词：胃癌 KI-67 癌胚抗原 预后 

分 类 号：R735.2[医药卫生—肿瘤]