BACKGROUND Ki-67 proliferation index is widely used for differentiating between high and low-grade gliomas, but differentiating between the same grade IV appears to be more problematic, and the point about its prognostic value for GBM patients remains unclear. To reduce the possibility to find a marked histological heterogeneity, and may contain areas that could be diagnosed as lower grade, in this study we considered a large group of patients with IDH wild-type Glioblastoma (IDH-WT GBM) and we have analyzed previously reported prognostic factors, in regards to their relationship with the Ki-67 expression index. METHODS We explore the prognostic impact of ki-67 index status in 127 patients affected by IDH-WT GBM. We therefore analyzed clinical characteristics, tumor genetics, dimension and clinical outcomes. We selected a total of 127 patients affected by newly diagnosed IDH-WT GBM who underwent surgery, radiation, and chemotherapy in our Institution in the period ranging between January 2014 and December 2016 RESULTS: The volume of the lesion had a strong association with the Ki67 overexpression. In particular lesions whose volume was greater than 45 cm3, presented a higher percentage of Ki67 expression demonstrating that greater tumors are more likely associated to higher values of Ki67 percentages. On a multivariate analysis, it was possible to outline that Ki67 was significant a predictor of shorter PFS independently from the age of the patients, the volume of the lesion and preoperative KPS. CONCLUSIONS There is a correlation between percentage staining of Ki-67 and OS in our cohort of patients with IDH-WT GBM. This is only the third observational study documenting a positive correlation between Ki-67 and overall survival in GBM and the first one demonstrates that percentage Ki-67 staining >20 % predicts poorer progression free survival in IDH-WT GBM.

中文翻译：

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IDH 野生型胶质母细胞瘤中的 Ki-67 指数过度表达是否预示着更短的无进展生存期？临床和分子分析研究

背景Ki-67增殖指数被广泛用于鉴别高、低级别胶质瘤，但鉴别同一IV级似乎更成问题，其对GBM患者的预后价值尚不清楚。为了减少发现显着组织学异质性的可能性，并且可能包含可以诊断为较低级别的区域，在本研究中，我们考虑了一大群 IDH 野生型胶质母细胞瘤 (IDH-WT GBM) 患者，我们之前已经分析过报告了预后因素，关于它们与 Ki-67 表达指数的关系。方法我们探讨了 127 名受 IDH-WT GBM 影响的患者的 ki-67 指数状态对预后的影响。因此，我们分析了临床特征、肿瘤遗传学、维度和临床结果。我们选择了 2014 年 1 月至 2016 年 12 月期间在我们机构接受手术、放疗和化疗的 127 名新诊断 IDH-WT GBM 患者结果：病变体积与 Ki67过度表达。特别是体积大于 45 cm3 的病变，表现出更高的 Ki67 表达百分比，表明更大的肿瘤更可能与更高的 Ki67 百分比值相关。在多变量分析中，有可能概述 Ki67 是 PFS 较短的显着预测因子，独立于患者年龄、病变体积和术前 KPS。结论 在我们的 IDH-WT GBM 患者队列中，Ki-67 的染色百分比与 OS 之间存在相关性。