Stoyanov George S, Dzhenkov Deyan L, Kitanova Martina, Donev Ivan S, Ghenev Peter
Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria.
Clinic of Oncology, St. Marina University Hospital Varna.
Cureus. 2017 Jun 26;9(6):e1396. doi: 10.7759/cureus.1396.
Background Glioblastoma multiforme (GBM) is a class IV astrocytic tumor, the most malignant of the four groups of World Health Organization (WHO) tumors with astrocytic differentiation. Aim The aim of this study was to estab-lish whether a correlation exists between the Ki-67 index of tumors with astrocytic differentiation, WHO grade, and patient survival. Materials and methods A retrospective non-clinical approach to patient selection was chosen for the aim of the study. A total of 47 patients diagnosed and treated for CNS tumors with astrocytic differentiation in the St. Marina University Hospital, Varna, Bulgaria, from September 2012 to July 2016 were retrospectively included into the study cohort. The cases were tested for their immunohistochemistry (IHC) reaction with Ki-67 after their original Hematoxylin and Eosin and IHC slides were reviewed by a single author and blind coded. The Ki-67 positivity index of the nuclei was estimated after digitalization of the slides and calculated by the ImmunoRatio automated count-ing tool. The individual Ki-67 index and patient survival of each case were statistically compared. Results The histopathological groups, after the blind Ki-67 index automated calculation was carried out, revealed no WHO grade I, two WHO grade II samples, four WHO grade III samples and 41 WHO grade IV cases, and these were included in the analysis. The two samples of WHO grade II astrocytic tumors had a mean Ki-67 index of 25%; however, they comprised tumors with an individual index of 43% and 7%, both individual values with a highly unlikely index for this group. The four samples of WHO grade III had a mean Ki-67 index of 4%, standard deviation ±2.16 (p>0.05), with the lowest index being 1% and the highest one being 6%. Both WHO grade II and III did not include enough samples to allow for a proper statistical analysis of patient survival. The 41 GBM cases had a mean Ki-67 index of 17.34%, standard deviation ±10.79 (p>0.05). Statistical analysis of the Ki-67 index divid-ed dichotomously into two groups and patient survival revealed that cases with a high Ki-67 index had no significant difference in survival when compared to those with low expression. Conclusions Based on the reported results, the mean Ki-67 percentage of positive nuclei in GBM tumor sam-ples cannot be used to estimate the survival of patients. However, Ki-67 remains a valuable IHC pathological tool.
背景 多形性胶质母细胞瘤（GBM）是一种IV级星形细胞瘤，是世界卫生组织（WHO）四类具有星形细胞分化的肿瘤中恶性程度最高的。目的 本研究旨在确定具有星形细胞分化的肿瘤的Ki-67指数、WHO分级与患者生存率之间是否存在相关性。材料和方法 为实现研究目的，选择了一种回顾性非临床患者选择方法。2012年9月至2016年7月在保加利亚瓦尔纳圣玛丽娜大学医院诊断并治疗的47例具有星形细胞分化的中枢神经系统肿瘤患者被回顾性纳入研究队列。在对原始苏木精和伊红染色切片及免疫组化切片由一位作者进行回顾并盲法编码后，对病例进行Ki-67免疫组化（IHC）反应检测。在对切片进行数字化处理后，估计细胞核的Ki-67阳性指数，并通过ImmunoRatio自动计数工具进行计算。对每个病例的个体Ki-67指数和患者生存率进行统计学比较。结果 在对Ki-67指数进行盲法自动计算后，组织病理学分组显示无WHO I级病例，有2例WHO II级样本，4例WHO III级样本和41例WHO IV级病例，这些被纳入分析。2例WHO II级星形细胞瘤样本的平均Ki-67指数为25%；然而，它们包括个体指数分别为43%和7%的肿瘤，这两个个体值在该组中极不可能出现。4例WHO III级样本的平均Ki-67指数为4%，标准差±2.16（p > 0.05），最低指数为1%，最高为6%。WHO II级和III级均没有足够的样本进行患者生存率的适当统计分析。41例GBM病例的平均Ki-67指数为17.34%，标准差±10.79（p > 0.05）。对Ki-67指数二分法分为两组与患者生存率的统计分析显示，Ki-67指数高的病例与低表达病例相比，生存率无显著差异。结论 根据报告结果，GBM肿瘤样本中阳性细胞核的平均Ki-67百分比不能用于估计患者的生存率。然而，Ki-67仍然是一种有价值的免疫组化病理工具。
