Ki-67在T1期非肌层浸润性膀胱癌中的表达及意义

摘要

目的:检测Ki-67在T1期非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)组织中的表达,并探讨其与肿瘤复发和进展的关系.方法:回顾性分析2011年6月至2013年10月天津医科大学肿瘤医院102例T1期NMIBC患者的临床病理资料,利用免疫组织化学方法检测组织中Ki-67的表达,分析Ki-67表达与患者临床病理特征的关系,探讨其对T1期NMIBC复发和进展的影响.结果:中位随访时间43(24~57)个月,102例T1期NMIBC患者中20例(19.6%)复发,12例(11.8%)进展,32例(31.4%)Ki-67表达≥25%.Ki-67表达与肿瘤分级相关(P<0.05),与患者性别、年龄、肿瘤数目、肿瘤大小等无相关性(P>0.05).单因素分析结果显示,Ki-67表达与T1期NMIBC的复发无相关性(P>0.05),Ki-67表达、肿瘤分级、肿瘤数目和既往复发率是影响T1期NMIBC进展的危险因素(P<0.05),Cox风险回归模型多因素分析结果显示,Ki-67高表达(P=0.043)和既往复发率(P=0.018)是影响T1期NMIBC进展的独立危险因素.结论:Ki-67表达是T1期NMIBC的独立预后因素,检测Ki-67表达有助于预测其进展风险,为采取及时有效治疗提供依据.%Objective:To evaluate the immunoreactivity of the Ki-67 protein in stage T1 non-muscle invasive bladder cancer (NMIBC) and determine the predictive role of Ki-67 expression. Methods:A retrospective study was performed on 102 patients with stage T1 NMIBC who underwent transurethral resection at the Tianjin Medical University Cancer Institute and Hospital from June 2011 to Octo-ber 2013. The expression of Ki-67 was evaluated using immunohistochemical assay and scored for intensity and area of staining. Then, the association between Ki-67 expression and categorical variable was analyzed. The predictive role of Ki-67 expression in tumor recur-rence and progression was assessed by univariate and multivariate analyses. Results:Of the 102 patients, 20 (19.6%) had tumor recur-rence and 12 (11.8%) progressed to muscle invasive disease, with a median follow-up of 43 months (range, 24-57 months). A high ex-pression of Ki-67 (determined using receiver operating characteristic curve analysis) was observed in 32 (31.4%) cases. This high ex-pression of Ki-67 correlated with tumor grade (P<0.05) but not with gender, age, tumor number, and tumor size (P>0.05). Univariate analysis revealed a correlation of tumor progression with Ki-67 expression, tumor grade, tumor number, and prior recurrence rate (P<0.05) but not between Ki-67 expression and tumor recurrence (P>0.05). Cox multivariate regression analysis showed that high Ki-67 ex-pression (P=0.043) and prior recurrence rate (P=0.018) are independent risk factors for predicting tumor progression. Conclusion:High Ki-67 expression is an independent prognostic factor for predicting tumor progression. Detection of its expression could predict the risk for progression in stage T1 NMIBC and provide the basis for appropriate treatment.