横纹肌肉瘤组织Ki-67表达与临床病理特征及预后的关系  

Relationships of Ki-67 expression with clinicopathological features and prognosis of rhabdomyosarcoma patients

作　　者：裴家鑫 吕新全[2] 周雅淑 苏彦威 路太英[1] PEI Jiaxin;LYU Xinquan;ZHOU Yashu;SU Yanwei;LU Taiying(Department of Oncology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院肿瘤科,河南郑州450052 [2]郑州大学第一附属医院病理科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第7期674-678,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202002068)。

摘　　要：目的 观察横纹肌肉瘤患者肿瘤组织Ki-67表达变化,探讨其与临床病理特征及预后的关系。方法 回顾性分析2017年1月—2022年12月郑州大学第一附属医院行手术治疗的118例横纹肌肉瘤患者(年龄≤18岁)的临床资料。随访至2023年4月,记录患者生存情况。绘制ROC曲线,评估Ki-67指数预测横纹肌肉瘤患者术后死亡的效能。以Ki-67指数预测横纹肌肉瘤患者术后死亡的最佳截断值为界,将118例患者分为高表达组和低表达组,比较2组性别、年龄、肿瘤最大直径、肿瘤位置、组织病理类型、TNM分期、美国横纹肌肉瘤研究组(IRS)分期等临床资料;绘制Kaplan-Meier生存曲线,比较2组总生存率;采用单因素及多因素Cox回归分析横纹肌肉瘤患者术后死亡的影响因素。结果 (1)随访至2023年4月30日,中位随访26.5个月,118例中生存77例,死亡41例。Ki-67指数以65%为最佳截断值,预测横纹肌肉瘤患者死亡的AUC为0.725(95%CI:0.633~0.817,P<0.001),灵敏度为73.2%,特异度为64.9%。(2)118例中61例Ki-67指数≤65%者为低表达组,57例Ki-67指数>65%者为高表达组。高表达组总生存率(47.4%)低于低表达组(82.0%)(χ^(2)=19.552,P<0.001)。(3)高表达组IRS分期Ⅳ期(33.3%)、中高危(57.9%)比率均高于低表达组(6.6%、31.1%)(P<0.05),男性、年龄>10岁、肿瘤最大直径>5 cm、肿瘤位置、TNM分期Ⅲ~Ⅳ期、术后放疗比率及组织病理类型与低表达组比较差异均无统计学意义(P>0.05)。(3)年龄>10岁(HR=2.582,95%CI:1.336~4.990,P=0.005)、Ki-67高表达(HR=3.328,95%CI:1.517~7.301,P=0.003)是横纹肌肉瘤患者术后死亡的危险因素,术后放疗(HR=0.267,95%CI:0.079~0.903,P=0.034)、危险度为低危(HR=0.398,95%CI:0.166~0.954,P=0.039)是横纹肌肉瘤患者术后死亡的保护因素。结论 Ki-67高表达的横纹肌肉瘤患者IRS分期晚,预后差;年龄>10岁、危险度为中高危、Ki-67指数>65%是影响横纹肌肉瘤患者术后死亡的危险因素,术后放�Objective To observe the expression of Ki-67in rhabdomyosarcoma patients,and to explore its relationship with clinicopathological features and prognosis.Methods Totally 118patients(≤18years old)with rhabdomyosarcoma undergoing surgical treatment in the First Affiliated Hospital of Zhengzhou University from January,2017to December,2022,and their clinical data were retrospectively analyzed.The patients were followed up till April,2023,and the survival of the patients was recorded.ROC curve was plotted to evaluate the efficiency of Ki-67on predicting the postoperative death.Taking the optimal cut-off value of Ki-67for predicting the postoperative death as the boundary value,118patients were divided into high-expression group and low-expression group.The gender,age,maximal tumor diameter,tumor location,histopathological type,TNM stage and Intergroup Rhabdomyosarcoma Study(IRS)stage were compared between two groups.Kaplan-Meier survival curve was plotted to compare the total survival rate between two groups.Univariate and multivariate Cox regression analyses were used to analyze the influencing factors of postoperative death in rhabdomyosarcoma patients.Results (1)The patients were followed up till April 30,2023,with a median follow-up of 26.5months.Of 118patients,77survived and 41died.When the optimal cut-offvalue of Ki-67was 65%,the AUCfor predicting death of rhabdomyosarcoma patients was 0.725(95%CI:0.633-0.817,P<0.001),with a sensitivity of 73.2%and specificity of 64.9%.(2)In 118patients,Ki-67was≤65%in 61patients(low-expression group)and was>65%in 57patients (high-expression group).The total survival rate was lower in high-expression group(47.4%)than that in low-expression group(82.0%)(χ^(2)=19.552,P<0.001).(3)The rates of IRS stageⅣand medium-high risk were higher in high-expression group (33.3%,57.9%)than those in low-expression group(6.6%,31.1%)(P<0.05).There were no significant differences in the proportions of males,age>10years old,maximal tumor diameter>5cm,tumor location,TNM stageⅢ-Ⅳand postopera

关 键 词：横纹肌肉瘤 KI-67 预后 

分 类 号：R738.7[医药卫生—肿瘤]