Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
Endocrine. 2023 Jul;81(1):107-115. doi: 10.1007/s12020-023-03328-4. Epub 2023 Feb 23.
The Ki67 index and lymph node ratio (LNR) have been proposed as components of alternative pathological classification schemes, but the most appropriate classification for patients with medullary thyroid cancer (MTC) remains unknown. The aim of the present study was to examine the usefulness of a new grading system combining the Ki67 index and LNR as a predictor of prognostic and disease-free survival (DFS) in MTC.
We conducted a retrospective study of patients with MTC who were registered at Sun Yat-sen University Cancer Center, Guangzhou, P. R. China from June 2003 to October 2021. The DFS rates were assessed using risk-adjusted Cox proportional hazard regression modeling to explore the relationship among pathological features, nutritional status and DFS. The Ki67 index (cutoff value: 5% and 10%) and LNR (cutoff value: 0.2 and 0.3) were combined to create a new grading system.
In total, 101 matched patients were assessed. The integrated grading system showed better separation of Kaplan Meier (KM) curves for DFS. As the grading stage progressed, there was a significant stepwise decrease in DFS, which was better than Ki67, LNR and N staging alone. According to the grading system, the high-risk group had a worse prognosis.
The proposed grading scheme demonstrated a better prognostic performance in MTC patients than the Ki67, LNR and N staging alone. However, larger scale studies are needed to further verify our findings.
Ki67 指数和淋巴结比率（LNR）已被提议作为替代病理分类方案的组成部分，但用于甲状腺髓样癌（MTC）患者的最佳分类仍不清楚。本研究旨在探讨一种新的分级系统，该系统将 Ki67 指数和 LNR 相结合，作为预测 MTC 患者预后和无病生存（DFS）的指标的有效性。
我们对 2003 年 6 月至 2021 年 10 月在中山大学肿瘤防治中心登记的 MTC 患者进行了回顾性研究。使用风险调整 Cox 比例风险回归模型评估 DFS 率，以探讨病理特征、营养状况与 DFS 之间的关系。Ki67 指数（临界值：5%和 10%）和 LNR（临界值：0.2 和 0.3）相结合创建了一个新的分级系统。
共评估了 101 例匹配患者。综合分级系统显示 DFS 的 Kaplan-Meier（KM）曲线分离效果更好。随着分级阶段的进展，DFS 呈显著逐步下降，明显优于 Ki67、LNR 和 N 分期。根据分级系统，高危组预后较差。
与 Ki67、LNR 和 N 分期相比，该拟议的分级方案在 MTC 患者中显示出更好的预后性能。然而，需要更大规模的研究来进一步验证我们的发现。
