He Yuhui, Wang Ning, Zhou Xiaofeng, Wang Jianfeng, Ding Zhenshan, Chen Xing, Deng Yisen
Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
Department of Urology, China-Japan Friendship Hospital, Beijing, China.
BMJ Open. 2018 Apr 17;8(4):e019635. doi: 10.1136/bmjopen-2017-019635.
The aim of this study was to explore the prognostic value of ki67 as a marker in patients with non-muscle invasive bladder cancer (NMIBC) treated with BCG.
Studies were systematically retrieved from the relevant databases (Web of Science, PubMed, Cochrane Library and Embase), and the expiry date was May 2017. The research steps referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
A total of 11 studies that complied with the inclusion criteria were included. The expression of ki67 was not statistically significantly associated with recurrence-free survival (RFS) (HR 1.331; 95% CI 0.980 to 1.809). No significant heterogeneity was found among all included studies ( =36.7%, p=0.148). The expression of ki67 was statistically significantly associated with progression-free survival (PFS) (HR 2.567; 95% CI 1.562 to 4.219), and the overexpression of ki67 was the risk factor for PFS. Significant heterogeneity was noted among all the included studies ( =55.6%, p=0.021). The studies that might cause heterogeneity were excluded using the Galbraith plot, and then the meta-analysis was performed again. The results showed that the expression of ki67 was still associated with PFS (HR 2.922; 95% CI 2.002 to 4.266).
The overexpression of ki67 was the risk factor for PFS, and the relationship between the expression of ki67 and RFS was not statistically significant in patients with NMIBC treated with BCG intravesical immunotherapy. Well-designed, prospective, with a large sample size are still needed to validate the findings.
本研究旨在探讨ki67作为卡介苗治疗的非肌层浸润性膀胱癌（NMIBC）患者预后标志物的价值。
从相关数据库（科学网、PubMed、考克兰图书馆和Embase）系统检索研究，截止日期为2017年5月。研究步骤参照系统评价和Meta分析的首选报告项目声明。
共纳入11项符合纳入标准的研究。ki67的表达与无复发生存期（RFS）无统计学显著相关性（HR 1.331；95%CI 0.980至1.809）。所有纳入研究之间未发现显著异质性（I² = 36.7%，p = 0.148）。ki67的表达与无进展生存期（PFS）有统计学显著相关性（HR 2.567；95%CI 1.562至4.219），ki67的过表达是PFS的危险因素。所有纳入研究之间存在显著异质性（I² = 55.6%，p = 0.021）。使用Galbraith图排除可能导致异质性的研究，然后再次进行Meta分析。结果显示，ki67的表达仍与PFS相关（HR 2.922；95%CI 2.002至4.266）。
ki67的过表达是PFS的危险因素，在接受膀胱内免疫治疗卡介苗的NMIBC患者中，ki67的表达与RFS之间的关系无统计学显著意义。仍需要设计良好、前瞻性、大样本量的研究来验证这些发现。
