Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Prostate. 2024 Jul;84(10):932-944. doi: 10.1002/pros.24710. Epub 2024 Apr 17.
KI67 is a well-known biomarker reflecting cell proliferation. We aim to elucidate the predictive role of KI67 in the efficacy of abiraterone for patients with advanced prostate cancer (PCa).
Clinicopathological data of 152 men with metastatic PCa, who received abiraterone therapy were retrospectively collected. The KI67 positivity was examined by immunohistochemistry using the prostate biopsy specimen. The predictive value of KI67 on the therapeutic efficacy of abiraterone was explored using Kaplan-Meier curve and Cox regression analysis. The endpoints included prostate-specific antigen (PSA) progression-free survival (PSA-PFS), radiographic PFS (rPFS), and overall survival (OS).
In total, 85/152 (55.9%) and 67/152 (44.1%) cases, respectively, received abiraterone at metastatic hormone-sensitive (mHSPC) and castration-resistant PCa (mCRPC) stage. The median KI67 positivity was 20% (interquartile range: 10%-30%). Overall, KI67 rate was not correlated with PSA response. Notably, an elevated KI67-positive rate strongly correlated with unfavorable abiraterone efficacy, with KI67 ≥ 30% and KI67 ≥ 20% identified as the optimal cutoffs for prognosis differentiation in mHSPC (median PSA-PFS: 11.43 Mo vs. 26.43 Mo, p < 0.001; median rPFS: 16.63 Mo vs. 31.90 Mo, p = 0.003; median OS: 21.77 Mo vs. not reach, p = 0.005) and mCRPC (median PSA-PFS: 7.17 Mo vs. 12.20 Mo, p = 0.029; median rPFS: 11.67 Mo vs. 16.47 Mo, p = 0.012; median OS: 21.67 Mo vs. not reach, p = 0.073) patients, respectively. Multivariate analysis supported the independent predictive value of KI67 on abiraterone efficacy. In subgroup analysis, an elevated KI67 expression was consistently associated with unfavorable outcomes in the majority of subgroups. Furthermore, data from another cohort of 79 PCa patients with RNA information showed that those with KI67 RNA levels above the median had a significantly shorter OS than those below the median (17.71 vs. 30.72 Mo, p = 0.035).
This study highlights KI67 positivity in prostate biopsy as a strong predictor of abiraterone efficacy in advanced PCa. These insights will assist clinicians in anticipating clinical outcomes and refining treatment decisions for PCa patients.
Ki67 是一种众所周知的反映细胞增殖的生物标志物。我们旨在阐明 Ki67 在晚期前列腺癌（PCa）患者接受阿比特龙治疗中的疗效预测作用。
回顾性收集了 152 名接受阿比特龙治疗的转移性 PCa 男性的临床病理数据。使用前列腺活检标本通过免疫组织化学检查 Ki67 阳性率。使用 Kaplan-Meier 曲线和 Cox 回归分析探讨 Ki67 对阿比特龙治疗效果的预测价值。终点包括前列腺特异性抗原（PSA）无进展生存期（PSA-PFS）、影像学无进展生存期（rPFS）和总生存期（OS）。
总共，85/152（55.9%）和 67/152（44.1%）例分别在转移性激素敏感（mHSPC）和去势抵抗性 PCa（mCRPC）阶段接受阿比特龙治疗。Ki67 阳性率中位数为 20%（四分位距：10%-30%）。总体而言，Ki67 率与 PSA 反应无关。值得注意的是，高 Ki67 阳性率与阿比特龙疗效不佳密切相关，Ki67≥30%和 Ki67≥20%被确定为 mHSPC 中预后分化的最佳截断值（PSA-PFS：中位 11.43 个月 vs. 26.43 个月，p<0.001；rPFS：中位 16.63 个月 vs. 31.90 个月，p=0.003；OS：中位 21.77 个月 vs. 未达到，p=0.005）和 mCRPC（PSA-PFS：中位 7.17 个月 vs. 12.20 个月，p=0.029；rPFS：中位 11.67 个月 vs. 16.47 个月，p=0.012；OS：中位 21.67 个月 vs. 未达到，p=0.073）患者。多变量分析支持 Ki67 对阿比特龙疗效的独立预测价值。在亚组分析中，升高的 Ki67 表达在大多数亚组中始终与不良结局相关。此外，来自另一组 79 名具有 RNA 信息的 PCa 患者的数据表明，Ki67 RNA 水平高于中位数的患者 OS 明显短于中位数以下的患者（17.71 个月 vs. 30.72 个月，p=0.035）。
本研究强调了前列腺活检中的 Ki67 阳性作为晚期 PCa 中阿比特龙疗效的强烈预测因子。这些见解将帮助临床医生预测临床结果，并为 PCa 患者的治疗决策提供参考。
