Ann Surg Treat Res.  2019 Jan;96(1):27-33. 10.4174/astr.2019.96.1.27.

Ki-67 labeling index as a prognostic marker in advanced stomach cancer

Affiliations
  • 1Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea.
  • 2Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Korea. rtyoon@gmail.com
  • 3Division of Oncology/Hematology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
  • 4Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea.
  • 5Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea.

Abstract

PURPOSE
Proliferation marker Ki-67 is widely used in cancer prognosis prediction. We tried to investigate the role of Ki-67 as a prognostic factor in stomach cancer after surgery in this study.
METHODS
We retrospectively evaluated 251 patients who underwent curative resection for gastric cancer from 2010 to 2015. In pathologic examination, Ki-67 labeling index was defined as the percentage of Ki-67 antigen positive cells. Prognostic significance of Ki-67 for gastric cancer was evaluated. Disease-free survival (DFS) was assessed as a primary end-point.
RESULTS
The median follow-up period was 28.0 months. Thirty-one patients (12.4%) showed Ki-67 labeling index (LI) lower than 25%. Sixty-eight patients (26.6%) showed recurrence during follow-up period. Recurrence was associated with Ki-67 LI level (≤25%, P = 0.016), and lymph node metastasis status (P = 0.002). High Ki-67 LI level (>25%) was also related to p53 positivity (P < 0.001) and poorly cohesive type (P = 0.002). The 3-year DFS was 69.4%. Low Ki-67 LI level (≤25%) was related with low DFS (47.6% vs. 72.6%, P = 0.016). T stage (P < 0.001), N stage (P = 0.006), lymphovascular invasion (P = 0.010), and neuronal invasion (P = 0.001) also affected the DFS. In addition, T stage (P = 0.03) and Ki-67 LI (P = 0.035) were independent prognostic factors for DFS. In patients treated with adjuvant chemotherapy (n = 239, 93.4%), low Ki-67 (≤25%) was a poor prognostic factor for DFS (P = 0.013).
CONCLUSION
Low Ki-67 LI predicts high rate of progression and low DFS of stomach cancer. Ki-67 LI can be a predictive marker in resected stomach cancer treated with surgery and adjuvant chemotherapy.

Keyword

Stomach neoplasms; Ki-67; Survival; Prognosis

MeSH Terms

Chemotherapy, Adjuvant
Disease-Free Survival
Follow-Up Studies
Humans
Ki-67 Antigen
Lymph Nodes
Neoplasm Metastasis
Neurons
Prognosis
Recurrence
Retrospective Studies
Stomach Neoplasms*
Stomach*
Ki-67 Antigen

Figure

  • Fig. 1 Overall survival (OS) and disease-free survival (DFS).

  • Fig. 2 Disease-free survival according to Ki-67 labeling index (LI) in all patients.

  • Fig. 3 Disease-free survival in patients treated with adjuvant chemotherapy according to Ki-67 labeling index (LI).


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