Wen Song, Zhou Wei, Li Chun-Ming, Hu Juan, Hu Xiao-Ming, Chen Ping, Shao Guo-Liang, Guo Wu-Hua
Department of Interventional Radiology, Zhejiang tumor hospital, Hangzhou, 310022, China.
Interventional Room of Oncology, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
BMC Cancer. 2015 Jul 15;15:520. doi: 10.1186/s12885-015-1524-2.
Despite the large number of published papers analyzing the prognostic role of Ki-67 in NSCLC, it is still not considered an established factor for routine use in clinical practice. The present meta-analysis summarizes and analyses the associations between Ki-67 expression and clinical outcome in NSCLC patients.
PubMed, Cochrane, and Embase databases were searched systematically using identical search strategies. The impacts of Ki-67 expression on survival in patients with NSCLC and NSCLC subtypes were evaluated. Furthermore, the association between Ki-67 expression and the clinicopathological features of NSCLC were evaluated.
In total, 32 studies from 30 articles met the inclusion criteria, involving 5600 patients. Meta-analysis results suggested that high Ki-67 expression was negatively associated with overall survival (OS; HR = 1.59, 95 % CI 1.35-1.88, P < 0.001) and disease-free survival (DFS; HR = 2.21, 95 % CI 1.43-3.42, P < 0.001) in NSCLC patients. Analysis of the different subgroups of NSCLC suggested that the negative association between high Ki-67 expression and OS and DFS in Asian NSCLC patients was stronger than that in non-Asian NSCLC patients, particularly in early-stage (Stage I-II) adenocarcinoma (ADC) patients. Additionally, while high expression was more common in males, smokers, and those with poorer differentiation, there was no correlation between high Ki-67 expression and age or lymph node status. Importantly, significant correlations between high Ki-67 expression and clinicopathological features (males, higher tumor stage, poor differentiation) were seen only in Asian NSCLC patients.
The present meta-analysis indicated that elevated Ki-67 expression was associated with a poorer outcome in NSCLC patients, particularly in early-stage Asian ADC patients. Studies with larger numbers of patients are needed to validate our findings.
尽管有大量已发表的论文分析了Ki-67在非小细胞肺癌（NSCLC）中的预后作用，但它仍未被视为临床实践中常规使用的既定因素。本荟萃分析总结并分析了Ki-67表达与NSCLC患者临床结局之间的关联。
使用相同的检索策略系统检索PubMed、Cochrane和Embase数据库。评估Ki-67表达对NSCLC患者及其亚型生存的影响。此外，还评估了Ki-67表达与NSCLC临床病理特征之间的关联。
总共30篇文章中的32项研究符合纳入标准，涉及5600例患者。荟萃分析结果表明，Ki-67高表达与NSCLC患者的总生存期（OS；HR = 1.59，95%CI 1.35 - 1.88，P < 0.001）和无病生存期（DFS；HR = 2.21，95%CI 1.43 - 3.42，P < 0.001）呈负相关。对NSCLC不同亚组的分析表明，亚洲NSCLC患者中Ki-67高表达与OS和DFS之间的负相关比非亚洲NSCLC患者更强，特别是在早期（I-II期）腺癌（ADC）患者中。此外，虽然高表达在男性、吸烟者和分化较差的患者中更常见，但Ki-67高表达与年龄或淋巴结状态之间没有相关性。重要的是，仅在亚洲NSCLC患者中观察到Ki-67高表达与临床病理特征（男性、更高肿瘤分期、低分化）之间存在显著相关性。
本荟萃分析表明，Ki-67表达升高与NSCLC患者预后较差相关，特别是在早期亚洲ADC患者中。需要更多患者的研究来验证我们的发现。
