关键词: 胃癌, Ki-67, 癌胚抗原, 预后

Abstract:

【Abstract】Objective To investigate the relationship between Ki-67 expression and the clinicopathologic features and prognosis of patients with carcinoembryonic antigen (CEA) and gastric cancer after surgery. Methods Retrospective analysis of clinical and follow-up data of patients who underwent radical gastrectomy for cancer at the Jiangsu Oncology Hospital between January 2015 and December 2016. The serum CEA expression was detected by electrochemiluminescence within 1 week before operation, the expression of Ki-67 was detected by immunohistochemistry. Correlation between Ki-67, CEA expression, and clinicopathologic characteristics was analyzed using the Pearson chi-square test. Kaplan-Meier analysis method, Log-rank test, and Cox regression model were used to analyze the prognostic impact of Ki-67 or combined CEA. Results Of 798 patients with postoperative gastric cancer, 368(46.1%) had Ki-67 high expression. Ki-67 expression was associated with age (P＜0.01), TNM stage (Ⅲ vs. Ⅰ, P＝0.036), T stage (T₄ vs. T1-T3, P＜0.001) and CEA (P＝0.01), but not N stage (P>0.05). CEA correlates with clinical stage (stage Ⅰ-Ⅲ , P＝0.003). The 5-year overall survival (OS) rate for all patients was 68.4%. Cox regression analysis showed that age (P＜0.001), TNM stage (P＜0.001), Ki-67 (P＝0.04), and CEA (P＝0.006) were independent predictors of survival after gastric cancer surgery. The 5-year OS rate of patients with stage Ⅲ with Ki-67-L and CEA-normal-expression (CEA-N) was higher than that of patients with high expression (59.8% vs. 48.9%,P＝0.003;60.4% vs.43.8%,P＝0.003), but no correlation was found in patients with stage Ⅰ and Ⅱ. Statistically significant differences in 5-year OS were observed between low-risk (Ki-67-L + CEA-N) group, intermediate-risk (Ki-67-H or CEA-H) group, and high-risk (Ki-67-H + CEA-H) groups (76.3% vs. 66.7% vs. 55.1%, P＜0.001) group. In patients with stage Ⅱ and Ⅲ, the 5-year OS rate was higher in low-risk group than in the intermediate-risk or high-risk group (78.4% vs. 79.1% vs. 61.4%, P＝0.008;68.2% vs. 47.3% vs. 46.3%, P＜0.001). Conclusion Ki-67 may affect survival in patients with gastric cancer after surgery, combined detection of Ki-67 and CEA contributes to improved predicting prognosis in patients with stage Ⅱ and Ⅲ gastric cancer.

Key words: Gastric cancer, Ki-67, Carcinoembryonic antigen, Prognosis