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Ann Surg Treat Res. 2019 Jan;96(1):27-33. English. Original Article.
Seo SH , Kim KH , Oh SH , Choi Y , Ahn KJ , Lee JY , Lee SM , Park J , Kim WG .
Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea.
Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Korea.
Division of Oncology/Hematology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea.
Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea.


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.


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.


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).


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.

Copyright © 2019. Korean Association of Medical Journal Editors.