Peng Rende, Zhang Yaoyu, Jia Mingzhu, Yi Xinping, Yi Xiaoyao, Li Shadan, Pi Jiangchuan, Meng Wenjun
Department of Urology, Chengdu Second People's Hospital, Chengdu, China.
Department of Urology, The General Hospital of Western Theater Command, Chengdu, China.
Front Oncol. 2025 Jan 16;14:1522009. doi: 10.3389/fonc.2024.1522009. eCollection 2024.
To investigate the optimal cut-off value of immunohistochemical marker Ki67 as a prognostic factor to predict the recurrence of non-muscle invasive bladder urothelial carcinoma (NMIBUC).
A total of 331 patients diagnosed with NMIBUC who underwent surgery in the Yongchuan Hospital and the Second Affiliated Hospital of Chongqing Medical University from January 2012 to January 2020 were finally included in this study. The optimal cut-off value of Ki67 for predicting recurrence of NMIBUC was calculated by ROC curve and Youden index. According to the cut-off value, the patients were divided into high ratio group and low ratio group, and the clinicopathological data of the two groups were compared. Univariate and multivariate regression analysis were used to analyze the relationship between the expression of Ki67 and postoperative recurrence of NMIBUC. The Kaplan-Meier curve was used for survival analysis.
18% is the optimal cut-off value of Ki67 for predicting postoperative recurrence of NMIBUC. High Ki67 expression (Ki67>18%) was significantly correlated with tumor stage (P=0.001), tumor grade (P=0.014), immediate postoperative instillation (P=0.001), the expression of P53 (P=0.019) and CK20 (P=0.001). Ki67 expression greater than 18% was an independent risk factor for high recurrence rate of NMIBUC (P=0.001). Moreover, the 1-year and 3-year recurrence-free survival (RFS) of the high Ki67 group were 56.6% (95%CI 51.2%-62%) and 43.6% (95%CI 37.5%-49.7%) respectively, which were significantly lower than those in low Ki67 group which present as 92.9% (95%CI 89.0%-96.8%) and 88.3% (95%CI 82.4%-94.2%) respectively, and the difference was statistically significant (P<0.001).
18% is the optimal cut-off value of Ki67 for predicting recurrence of NMIBUC. Ki67>18% is an independent risk factor for high recurrence rate of NMIBUC. This cut-off value can more accurately predict the risk of recurrence and has the potential clinical value for guiding the postoperative adjuvant treatment and follow-up strategy of NMIBUC.
探讨免疫组化标志物Ki67作为预测非肌层浸润性膀胱尿路上皮癌（NMIBUC）复发的预后因素的最佳临界值。
最终纳入2012年1月至2020年1月在重庆医科大学附属永川医院和第二附属医院接受手术治疗的331例NMIBUC患者。通过ROC曲线和约登指数计算Ki67预测NMIBUC复发的最佳临界值。根据该临界值将患者分为高比例组和低比例组，比较两组的临床病理资料。采用单因素和多因素回归分析分析Ki67表达与NMIBUC术后复发的关系。采用Kaplan-Meier曲线进行生存分析。
18%是Ki67预测NMIBUC术后复发的最佳临界值。高Ki67表达（Ki67>18%）与肿瘤分期（P=0.001）、肿瘤分级（P=0.014）、术后即刻灌注（P=0.001）、P53表达（P=0.019）和CK20表达（P=0.001）显著相关。Ki67表达大于18%是NMIBUC高复发率的独立危险因素（P=0.001）。此外，高Ki67组的1年和3年无复发生存率（RFS）分别为56.6%（95%CI 51.2%-62%）和43.6%（95%CI 37.5%-49.7%），显著低于低Ki67组，低Ki67组分别为92.9%（95%CI 89.0%-96.8%）和88.3%（95%CI 82.4%-94.2%），差异有统计学意义（P<0.001）。
18%是Ki67预测NMIBUC复发的最佳临界值。Ki67>18%是NMIBUC高复发率的独立危险因素。该临界值能更准确地预测复发风险，对指导NMIBUC的术后辅助治疗和随访策略具有潜在临床价值。
