發(fā)布時(shí)間：2018-07-29 14:42

【摘要】：目的 Ki-67是細(xì)胞增殖的相關(guān)抗原,Ki-67指數(shù)是區(qū)分乳腺癌Luminal A型和Luminal B型的重要生物學(xué)指標(biāo),高Ki-67指數(shù)往往預(yù)示著不良的預(yù)后。然而在三陰性乳腺癌(triple negative breast cancer,TNBC)中,Ki-67預(yù)后價(jià)值尚不明確。本研究旨在探討TNBC中Ki-67指數(shù)的預(yù)后價(jià)值。方法回顧性分析鄭州大學(xué)附屬腫瘤醫(yī)院2009-01-06-2010-12-30收治的310例經(jīng)病理確診為TNBC并有完整資料和隨訪數(shù)據(jù)患者的臨床及病理資料,分析Ki-67指數(shù)等指標(biāo)對患者生存預(yù)后影響。利用SPSS 17.0軟件,計(jì)數(shù)資料比較采用χ~2檢驗(yàn)。Ki-67診斷價(jià)值及截?cái)嘀挡捎肦OC曲線進(jìn)行分析。生存分析采用Kaplan-Meier法,并進(jìn)行Log-rank檢驗(yàn)。多因素分析采用Cox比例風(fēng)險(xiǎn)模型。結(jié)果中位隨訪時(shí)間65個(gè)月(3~81個(gè)月),310例乳腺癌患者中復(fù)發(fā)68例(21.9%),死亡49例(15.8%),其中48例死于乳腺癌(15.5%)。Ki-67指數(shù)與患者月經(jīng)狀態(tài)(χ~2=8.484,P=0.014)、腫瘤大小(χ~2=17.580,P=0.007)、腋窩淋巴結(jié)狀態(tài)(χ~2=30.071,P0.001)以及組織學(xué)分級(χ~2=17.626,P=0.001)均相關(guān)。低(Ki-67≤20%)、中(20%Ki-67≤50%)、高Ki-67組(Ki-6750%)5年無病生存率(disease-free survival,DFS)分別為96.5%、87.3%和64.9%,差異有統(tǒng)計(jì)學(xué)意義,P0.001;5年總生存率(overall survival,OS)分別為96.5%、90.2%和75.5%,差異有統(tǒng)計(jì)學(xué)意義,P0.001。Ki-67評價(jià)TNBC患者DFS及OS的ROC曲線下面積分別為0.707和0.689,Ki-67評價(jià)預(yù)后最佳截?cái)嘀禐?7.5%。單因素分析中,Ki-67指數(shù)(χ~2=31.779,P0.001)、腫瘤大小(χ~2=140.260,P0.001)、腋窩淋巴結(jié)狀態(tài)(χ~2=120.467,P0.001)和組織學(xué)分級(χ~2=8.765,P=0.012)是影響TNBC患者DFS的相關(guān)因素,Ki-67指數(shù)(χ~2=18.218,P0.001)、腫瘤大小(χ~2=299.718,P0.001)、腋窩淋巴結(jié)狀態(tài)(χ~2=68.794,P0.001)和組織學(xué)分級(χ~2=7.572,P=0.023)是影響TNBC患者OS的相關(guān)因素;多因素分析中,Ki-67指數(shù)(HR=2.074,95%CI:1.279~3.364,P=0.003)、腫瘤大小(RR=1.879,95%CI:1.152~3.062,P=0.011)和腋窩淋巴結(jié)狀態(tài)(RR=2.345,95%CI:1.825~3.015,P0.001)是影響患者DFS的獨(dú)立因素,Ki-67指數(shù)(RR=1.752,95%CI:1.020~3.008,P=0.042)、腫瘤大小(RR=20.011,95%CI:1.132~3.574,P=0.017)和腋窩淋巴結(jié)狀態(tài)(RR=2.021,95%CI:1.517~2.693,P0.001)是影響患者OS的獨(dú)立因素。結(jié)論 Ki-67指數(shù)與TNBC患者預(yù)后相關(guān),高Ki-67指數(shù)患者預(yù)后不良,Ki-67指數(shù)有望成為判斷TNBC患者預(yù)后的一項(xiàng)重要生物學(xué)指標(biāo)。
[Abstract]:Objective Ki-67 is the antigen associated with cell proliferation and Ki-67 index is an important biological index to distinguish Luminal A type from Luminal B type in breast cancer. High Ki-67 index often predicts poor prognosis. However, the prognostic value of Ki-67 in triple negative breast cancer (triple negative breast cancer-TNBC) remains unclear. The purpose of this study was to investigate the prognostic value of Ki-67 index in TNBC. Methods the clinical and pathological data of 310 patients with TNBC diagnosed pathologically in the affiliated Cancer Hospital of Zhengzhou University 2009-01-06-2010-12-30 were analyzed retrospectively. The influence of Ki-67 index on the survival and prognosis of the patients was analyzed. The diagnostic value of Ki-67 and the truncation value were analyzed by ROC curve and 蠂 ~ 2 test by using SPSS 17.0 software. Kaplan-Meier method and Log-rank test were used for survival analysis. Cox proportional risk model was used in multivariate analysis. Results the median follow-up time was 65 months (3 ~ 81 months). 68 cases (21.9%) had recurrence and 49 cases (15.8%) died of breast cancer. Among them, 48 cases died from breast cancer (15.5%). Ki-67 index was correlated with menstrual status (蠂 ~ 2J ~ (2.48 4) P ~ (0.014), tumor size (蠂 ~ (217.580) P _ (0.007), axillary lymph node status (蠂 ~ (22) 30.071 P _ 0.001) and histological grade (蠂 ~ (2) ~ (17.626) P ~ (0.001). Low (Ki-67 鈮，

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