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Pulmonary neuroendocrine carcinoid tumors: Is there a predictive role to the Ki 67 index?
Annals of Thoracic Medicine ( IF 2.3 ) Pub Date : 2021-07-01 , DOI: 10.4103/atm.atm_599_20 Ana Karina Patané 1 , Gabriela Guma 2 , Mercedes Rayá 2 , Adolfo Rosales 1, 3 , Walter Astorino 3 , Moisés Rosenberg 3
INTRODUCTION: There are several factors predicting evolution in carcinoid tumors (CT) to date including the Ki67 role.
AIMS: The aim of this study is to identify a KI67 cut-off point for a population of CT and determine its prognostic implication in global and disease-free survival.
METHODS: Hematoxylin-eosin slides of 102 CT were revised. The percentage of cells expressing Ki 67 was determined manually.
STATISTICAL ANALYSIS: The variables were compared with the t-test or the Wilcoxon test according to their distribution, the categorical ones with Chi-square or Fisher's test. The best cut-off point was established by constructing receiver operating characteristic curves, then using that value as a dichotomous variable.
RESULTS: 72 typical carcinoids (TC) and 30 atypical carcinoids (AC) were analyzed; 66% were female. Median age (TC 38 vs. AC 51, P = 0.001), Ki67 expression (TC 0.63 vs. AC 2, P = 0.003), tumor size (TC 2.5 vs. AC 2.6, P = 0.001), the percentage relapse (TC 3.4% vs. AC 23%, P = 0.006), and the number of deaths (TC 1 vs. AC 4, P = 0.042) were significantly higher in the AC subgroup. The best cut-off point for Ki 67 was 0.755 (area under the curve AUC 0.564, 95% confidence interval 0.270–0.857), with no significant differences found in the disease-free and overall survival curves when considering values < or ≥ at the established cut-off point. The best cut-off point of the Ki-67 when exclusively analyzing AC was 1.18. When using this value as a predictive variable, a marginal statistical association was observed between Ki-67 expression, mortality (P = 0.077), and the frequency of relapses (P = 0.054).
CONCLUSIONS: Histological type is the best predictor of prognosis in the carcinoid tumor group. In the AC subgroup, the marginal association between mortality, frequency of relapses and Ki values 67 ≥ 1.18 has clinical relevance future analyses are required to determine the real predictive value of this variable.
中文翻译：
肺神经内分泌类癌：Ki 67 指数有预测作用吗？
介绍：迄今为止，有几个因素可以预测类癌 (CT) 的演变，包括 Ki67 的作用。
目的：本研究的目的是确定 CT 人群的 KI67 截止点，并确定其对全球和无病生存的预后意义。
方法：对102张CT的苏木精-伊红切片进行修订。手动确定表达 Ki 67 的细胞百分比。
统计分析：变量根据其分布与t检验或 Wilcoxon 检验进行比较，分类变量采用卡方检验或 Fisher 检验。通过构建接收者操作特征曲线，然后使用该值作为二分变量来建立最佳截止点。
结果：分析了72种典型类癌（TC）和30种非典型类癌（AC）；66% 是女性。中位年龄（TC 38 与 AC 51，P = 0.001）、Ki67 表达（TC 0.63 与 AC 2，P = 0.003）、肿瘤大小（TC 2.5 与 AC 2.6，P = 0.001）、复发百分比（TC 3.4% vs. AC 23%，P = 0.006），以及死亡人数（TC 1 vs. AC 4，P= 0.042) 在 AC 亚组中显着更高。Ki 67 的最佳截止点是 0.755（曲线下面积 AUC 0.564，95% 置信区间 0.270–0.857），当考虑值 < 或 ≥确定的分界点。Ki-67 在专门分析 AC 时的最佳截止点是 1.18。当使用该值作为预测变量时，观察到 Ki-67 表达、死亡率 ( P = 0.077) 和复发频率 ( P = 0.054)之间存在边际统计关联。
结论：组织学类型是类癌组预后的最佳预测指标。在 AC 亚组中，死亡率、复发频率和 Ki 值 67 ≥ 1.18 之间的边际关联具有临床相关性，未来需要进行分析以确定该变量的真实预测值。
更新日期：2021-07-20
Annals of Thoracic Medicine ( IF 2.3 ) Pub Date : 2021-07-01 , DOI: 10.4103/atm.atm_599_20 Ana Karina Patané 1 , Gabriela Guma 2 , Mercedes Rayá 2 , Adolfo Rosales 1, 3 , Walter Astorino 3 , Moisés Rosenberg 3
Affiliation
INTRODUCTION: There are several factors predicting evolution in carcinoid tumors (CT) to date including the Ki67 role.
AIMS: The aim of this study is to identify a KI67 cut-off point for a population of CT and determine its prognostic implication in global and disease-free survival.
METHODS: Hematoxylin-eosin slides of 102 CT were revised. The percentage of cells expressing Ki 67 was determined manually.
STATISTICAL ANALYSIS: The variables were compared with the t-test or the Wilcoxon test according to their distribution, the categorical ones with Chi-square or Fisher's test. The best cut-off point was established by constructing receiver operating characteristic curves, then using that value as a dichotomous variable.
RESULTS: 72 typical carcinoids (TC) and 30 atypical carcinoids (AC) were analyzed; 66% were female. Median age (TC 38 vs. AC 51, P = 0.001), Ki67 expression (TC 0.63 vs. AC 2, P = 0.003), tumor size (TC 2.5 vs. AC 2.6, P = 0.001), the percentage relapse (TC 3.4% vs. AC 23%, P = 0.006), and the number of deaths (TC 1 vs. AC 4, P = 0.042) were significantly higher in the AC subgroup. The best cut-off point for Ki 67 was 0.755 (area under the curve AUC 0.564, 95% confidence interval 0.270–0.857), with no significant differences found in the disease-free and overall survival curves when considering values < or ≥ at the established cut-off point. The best cut-off point of the Ki-67 when exclusively analyzing AC was 1.18. When using this value as a predictive variable, a marginal statistical association was observed between Ki-67 expression, mortality (P = 0.077), and the frequency of relapses (P = 0.054).
CONCLUSIONS: Histological type is the best predictor of prognosis in the carcinoid tumor group. In the AC subgroup, the marginal association between mortality, frequency of relapses and Ki values 67 ≥ 1.18 has clinical relevance future analyses are required to determine the real predictive value of this variable.
中文翻译：
肺神经内分泌类癌：Ki 67 指数有预测作用吗？
介绍：迄今为止，有几个因素可以预测类癌 (CT) 的演变，包括 Ki67 的作用。
目的：本研究的目的是确定 CT 人群的 KI67 截止点，并确定其对全球和无病生存的预后意义。
方法：对102张CT的苏木精-伊红切片进行修订。手动确定表达 Ki 67 的细胞百分比。
统计分析：变量根据其分布与t检验或 Wilcoxon 检验进行比较，分类变量采用卡方检验或 Fisher 检验。通过构建接收者操作特征曲线，然后使用该值作为二分变量来建立最佳截止点。
结果：分析了72种典型类癌（TC）和30种非典型类癌（AC）；66% 是女性。中位年龄（TC 38 与 AC 51，P = 0.001）、Ki67 表达（TC 0.63 与 AC 2，P = 0.003）、肿瘤大小（TC 2.5 与 AC 2.6，P = 0.001）、复发百分比（TC 3.4% vs. AC 23%，P = 0.006），以及死亡人数（TC 1 vs. AC 4，P= 0.042) 在 AC 亚组中显着更高。Ki 67 的最佳截止点是 0.755（曲线下面积 AUC 0.564，95% 置信区间 0.270–0.857），当考虑值 < 或 ≥确定的分界点。Ki-67 在专门分析 AC 时的最佳截止点是 1.18。当使用该值作为预测变量时，观察到 Ki-67 表达、死亡率 ( P = 0.077) 和复发频率 ( P = 0.054)之间存在边际统计关联。
结论：组织学类型是类癌组预后的最佳预测指标。在 AC 亚组中，死亡率、复发频率和 Ki 值 67 ≥ 1.18 之间的边际关联具有临床相关性，未来需要进行分析以确定该变量的真实预测值。
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