Tanaka Kazuhiro, Hasegawa Tadashi, Nojima Takayuki, Oda Yoshinao, Mizusawa Junki, Fukuda Haruhiko, Iwamoto Yukihide
Department of Endoprosthetic Surgery, Oita University, Yufu, Oita, 879-5593, Japan.
Department of Surgical Pathology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
World J Surg Oncol. 2016 Apr 18;14:110. doi: 10.1186/s12957-016-0869-6.
The correct clinical staging of soft tissue sarcomas (STS) is critical for the selection of treatments. The staging system consists of histological grade of the tumors and French Federation of Cancer Center (FNCLCC) system based on mitotic count is widely used for the grading. In this study, we compared the validity and usefulness of Ki-67 grading system with FNCLCC system in JCOG0304 trial which investigated the efficacy and safety of perioperative chemotherapy with doxorubicin and ifosfamide for STS.
All 70 eligible patients with STS in the extremities treated by perioperative chemotherapy in JCOG0304 were analyzed. Univariate and multivariate Cox regression analyses were conducted to investigate an influence on overall survival.
The reproducibility of Ki-67 grading system in the histological grading of STS was higher than FNCLCC system (κ = 0.54 [95 % CI 0.39-0.71], and 0.46 [0.32-0.62], respectively). Although FNCLCC grade was not associated with overall survival (OS) in univariate analysis (HR 2.80 [0.74-10.55], p = 0.13), Ki-67 grading system had a tendency to associate with OS in univariate analysis (HR 4.12 [0.89-19.09], p = 0.07) and multivariate analysis with backward elimination (HR 3.51 [0.75-16.36], p = 0.11).
This is the first report demonstrating the efficacy of Ki-67 grading system for the patients with STS in the prospective trial. The results indicate that Ki-67 grading system might be useful for the evaluation of histological grade of STS.
软组织肉瘤（STS）的正确临床分期对于治疗方案的选择至关重要。分期系统包括肿瘤的组织学分级，基于有丝分裂计数的法国癌症中心联合会（FNCLCC）系统被广泛用于分级。在本研究中，我们在JCOG0304试验中比较了Ki-67分级系统与FNCLCC系统在评估多柔比星和异环磷酰胺围手术期化疗治疗STS的疗效和安全性方面的有效性和实用性。
对JCOG0304中所有70例接受围手术期化疗的符合条件的四肢STS患者进行分析。进行单因素和多因素Cox回归分析以研究对总生存期的影响。
Ki-67分级系统在STS组织学分级中的可重复性高于FNCLCC系统（κ分别为0.54 [95%CI 0.39 - 0.71]和0.46 [0.32 - 0.62]）。虽然在单因素分析中FNCLCC分级与总生存期（OS）无关（HR 2.80 [0.74 - 10.55]，p = 0.13），但Ki-67分级系统在单因素分析中有与OS相关的趋势（HR 4.12 [0.89 - 19.09]，p = 0.07），在多因素向后逐步回归分析中也是如此（HR 3.51 [0.75 - 16.36]，p = 0.11）。
这是第一份在前瞻性试验中证明Ki-67分级系统对STS患者有效的报告。结果表明Ki-67分级系统可能有助于评估STS的组织学分级。
