Relationships of Ki-67 expression with clinicopathological features and prognosis of rhabdomyosarcoma patients
Objective To observe the expression of Ki-67 in rhabdomyosarcoma patients,and to explore its relationship with clinicopathological features and prognosis.Methods Totally 118 patients(≤18 years old)with rhabdomyosarcoma undergoing surgical treatment in the First Affiliated Hospital of Zhengzhou University from January,2017 to December,2022,and their clinical data were retrospectively analyzed.The patients were followed up till April,2023,and the survival of the patients was recorded.ROC curve was plotted to evaluate the efficiency of Ki-67 on predicting the postoperative death.Taking the optimal cut-off value of Ki-67 for predicting the postoperative death as the boundary value,118 patients were divided into high-expression group and low-expression group.The gender,age,maximal tumor diameter,tumor location,histopathological type,TNM stage and Intergroup Rhabdomyosarcoma Study(IRS)stage were compared between two groups.Kaplan-Meier survival curve was plotted to compare the total survival rate between two groups.Univariate and multivariate Cox regression analyses were used to analyze the influencing factors of postoperative death in rhabdomyosarcoma patients.Results(1)The patients were followed up till April 30,2023,with a median follow-up of 26.5 months.Of 118 patients,77 survived and 41 died.When the optimal cut-off value of Ki-67 was 65％,the AUC for predicting death of rhabdomyosarcoma patients was 0.725(95％CI:0.633-0.817,P＜0.001),with a sensitivity of 73.2％and specificity of 64.9％.(2)In 118 patients,Ki-67 was ≤65％in 61 patients(low-expression group)and was＞65％in 57 patients(high-expression group).The total survival rate was lower in high-expression group(47.4％)than that in low-expression group(82.0％)(x2=19.552,P＜0.001).(3)The rates of IRS stage Ⅳand medium-high risk were higher in high-expression group(33.3％,57.9％)than those in low-expression group(6.6％,31.1％)(P＜0.05).There were no significant differences in the proportions of males,age＞10 years old,maximal tumor diameter＞5 cm,tumor location,TNM stage Ⅲ-Ⅳ and postoperative radiotherapy as well as the histopathological type between two groups(P＞0.05).(4)Age＞10 years old(HR=2.582,95％CI:1.336-4.990,P=0.005)and Ki-67 high expression(HR=3.328,95％CI:1.517-7.301,P=0.003)were the risk factors of death of rhabdomyosarcoma patients,and postoperative radiotherapy(HR=0.267,95％CI:0.079-0.903,P=0.034)and low risk(HR=0.398,95％CI:0.166-0.954,P=0.039)were the protective factors of death.Conclusions The children with high expression of Ki-67 have advanced IRS stage and poor prognosis.Age＞10 years old,medium-high risk,and Ki-67＞65％are the risk factors of postoperative death of rhabdomyosarcoma patients,and postoperative radiotherapy can improve the prognosis.
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