Lei Hong Tao, Yan Shan, He Yin Hua, Xu Ning, Zhao Min, Yu Chun Jiao, Li Hong Lin, Kuang Sai, Cui Zhan Hang, Fang Jing
School of Public Health, Kunming Medical University, Kunming, Yunnan 650500, P.R. China.
Yunnan Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Biomedical Engineering, Kunming Medical University, Kunming, Yunnan 650500, P.R. China.
Oncol Lett. 2022 Oct 7;24(6):420. doi: 10.3892/ol.2022.13540. eCollection 2022 Dec.
The proliferation of the biomarker Ki67 has been extensively studied in colorectal cancer (CRC). Although numerous Ki67 cut-off values have previously been reported, the optimal cut-off value remains unclear with previous studies providing contrasting results. The present retrospective cohort study aimed to determine the optimal cut-off value for CRC. Ki67 levels and the prognosis of patients with non-metastatic CRC were obtained from the Electronic Health Information System of a tertiary hospital in Kunming City. The Restricted Cubic Spline (RCS) model was used to analyze the non-linear association between Ki67 levels and the risk of patient death and metastasis. Moreover, the RCS model was used to determine the optimal cut-off value of Ki67. Cox proportional hazards models were used to verify the effects of the cut-off value. In total, 210 patients with CRC and a median age of 62.5 years (age range, 23.0-88.0 years) were studied. Results of the present study demonstrated a non-linear association between Ki67 levels and the risk of patient death based on the RCS model, and at Ki67 levels ≥60%, the hazard ratio (HR) of patient death gradually increased. Using multivariate-adjusted Cox proportional hazards models, the results of the present study demonstrated that Ki67 ≥60% indicated a high-risk ratio for both distant metastasis and death [HR, 2.640; 95% confidence interval (CI), 1.066-6.539], compared with Ki67 <60% (HR, 2.558; 95% CI, 1.079-6.064). Therefore, Ki67 ≥60% may be the optimal cut-off value for the prediction of death and metastasis in patients with CRC. Thus, Ki67 may act as a biomarker for predicting the prognosis of patients with CRC, and the optimal cut-off value for the prediction of both death and metastasis of patients with CRC is 60%.
生物标志物Ki67的增殖情况已在结直肠癌（CRC）中得到广泛研究。尽管此前已报道过众多Ki67的临界值，但最佳临界值仍不明确，先前的研究给出了相互矛盾的结果。本项回顾性队列研究旨在确定CRC的最佳临界值。从昆明市一家三级医院的电子健康信息系统中获取了非转移性CRC患者的Ki67水平及预后情况。采用受限立方样条（RCS）模型分析Ki67水平与患者死亡及转移风险之间的非线性关联。此外，使用RCS模型确定Ki67的最佳临界值。采用Cox比例风险模型验证该临界值的作用。总共研究了210例CRC患者，中位年龄为62.5岁（年龄范围为23.0 - 88.0岁）。本研究结果表明，基于RCS模型，Ki67水平与患者死亡风险之间存在非线性关联，且当Ki67水平≥60%时，患者死亡的风险比（HR）逐渐升高。使用多变量调整的Cox比例风险模型，本研究结果表明，与Ki67 <60%（HR，2.558；95%置信区间[CI]，1.079 - 6.064）相比，Ki67≥60%表明远处转移和死亡的风险比均较高[HR，2.640；95%置信区间（CI），1.066 - 6.539]。因此，Ki67≥60%可能是预测CRC患者死亡和转移的最佳临界值。由此可见，Ki67可作为预测CRC患者预后的生物标志物，且预测CRC患者死亡和转移的最佳临界值为60%。
