Ki-67在三阴性乳腺癌中的预后和预测价值
2016年4月28日，美国《肿瘤标靶》杂志在线发表了上海交通大学医学院附属瑞金医院、上海交通大学电子信息与电气工程学院的研究报告，探讨了Ki-67在三阴性乳腺癌进一步分类中的预后作用，并检测了Ki-67高表达水平能否预测从卡铂获益。
该研究从2004年1月至2012年12月通过医院临床数据库确定了363例三阴性乳腺癌患者。经过34个月中位随访时间（范围：5.2～120.0个月），62例患者（17.1%）复发，33例患者（9.1%）死于乳腺癌。在单变量分析中，高Ki-67指数、肿瘤较大、淋巴结受累，与无病生存（DFS）和总生存期（OS）较短有相关性。在多变量分析中，高Ki-67是DFS（风险比[RR]：2.835，95%置信区间[95% CI]：1.586～5.068，P＜0.001）和OS（RR：3.180，95% CI：1.488～6.793，P=0.003）的独立风险因素。通过Ki-67分布分析3年DFS，亚组治疗效果模式图分析显示卡铂对高Ki-67指数患者产生有益影响。
总之，三阴性乳腺癌可能是一种具有不同特征和预后的异质性疾病，并且可以根据Ki-67表达水平进一步细分。高Ki-67组患者似乎从卡铂治疗获益更多，但这需要进一步验证。
Oncotarget. 2016 Apr 28. [Epub ahead of print]
Prognostic and predictive value of Ki-67 in triple-negative breast cancer.
Wang W, Wu J, Zhang P, Fei X, Zong Y, Chen X, Huang O, He JR, Chen W, Li Y, Shen K, Zhu L.
Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China.
Department of Information Engineering, Shanghai Jiaotong University, Shanghai, 200240, P.R. China.
This study was to investigate the prognostic role of Ki-67 in further classification of triple negative breast cancer (TNBC), and to test whether high expression level of Ki67 can predict benefit from carboplatin. From January 2004 to December 2012, 363 patients operated for TNBC were identified through the institutional clinical database. After a median follow-up time of 34 months (5.2-120.0 months), 62 patients (17.1%) had relapses and 33 patients (9.1%) died of breast cancer. In univariate analysis, high Ki-67 index as well as larger tumor size and lymph node involvement was associated with shorter disease-free survival (DFS) and overall survival (OS). In multivariate analysis, high Ki-67 is an independent risk factor for DFS (Risk Ratio, RR: 2.835, 95% confidence interval, 95% CI: 1.586-5.068, P < 0.001) and OS (RR: 3.180, 95% CI: 1.488-6.793, P = 0.003). When analyzing the 3-year DFS by Ki-67 distribution, Subpopulation Treatment Effect Pattern Plot analysis showed a beneficial effect of carboplatin in patients with high Ki-67 index. In conclusion, TNBC is probably a heterogeneous disease with different characteristics and prognosis, and may be further subdivided according to the Ki-67 expression levels. Patients in the high Ki- 67 group seem to benefit more from treatment with carboplatin, but this needs to be further verified.
KEYWORDS: breast carcinoma; hormonal receptor negativity; human epithelial growth factor receptor 2 negativity; platinum; proliferation index
PMID: 27145269
DOI: 10.18632/oncotarget.9075