Abstract
BackgroundDespite the large number of published papers analyzing the prognostic role of Ki-67 in NSCLC, it is still not considered an established factor for routine use in clinical practice. The present meta-analysis summarizes and analyses the associations between Ki-67 expression and clinical outcome in NSCLC patients.MethodsPubMed, Cochrane, and Embase databases were searched systematically using identical search strategies. The impacts of Ki-67 expression on survival in patients with NSCLC and NSCLC subtypes were evaluated. Furthermore, the association between Ki-67 expression and the clinicopathological features of NSCLC were evaluated.ResultsIn total, 32 studies from 30 articles met the inclusion criteria, involving 5600 patients. Meta-analysis results suggested that high Ki-67 expression was negatively associated with overall survival (OS; HR = 1.59, 95 % CI 1.35-1.88, P < 0.001) and disease-free survival (DFS; HR = 2.21, 95 % CI 1.43-3.42, P < 0.001) in NSCLC patients. Analysis of the different subgroups of NSCLC suggested that the negative association between high Ki-67 expression and OS and DFS in Asian NSCLC patients was stronger than that in non-Asian NSCLC patients, particularly in early-stage (Stage I-II) adenocarcinoma (ADC) patients. Additionally, while high expression was more common in males, smokers, and those with poorer differentiation, there was no correlation between high Ki-67 expression and age or lymph node status. Importantly, significant correlations between high Ki-67 expression and clinicopathological features (males, higher tumor stage, poor differentiation) were seen only in Asian NSCLC patients.ConclusionsThe present meta-analysis indicated that elevated Ki-67 expression was associated with a poorer outcome in NSCLC patients, particularly in early-stage Asian ADC patients. Studies with larger numbers of patients are needed to validate our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1524-2) contains supplementary material, which is available to authorized users.
Highlights
Despite the large number of published papers analyzing the prognostic role of Ki-67 in Nonsmall cell lung cancer (NSCLC), it is still not considered an established factor for routine use in clinical practice
A large meta-analysis involving 17 studies published in 2004 showed that high expression of Ki-67 was associated with a poorer overall survival (hazard ratio (HR) 1.56, 95 % confidence interval (CI) 1.30–1.87), it did not evaluate the association between Ki-67 expression and disease-free survival
Literature search and study characteristics We identified 2046 potentially relevant articles through the search strategy described in Methods
Summary
Despite the large number of published papers analyzing the prognostic role of Ki-67 in NSCLC, it is still not considered an established factor for routine use in clinical practice. Despite the large number of published papers analyzing the prognostic role of Ki-67 in NSCLC, it is still not considered an established factor for routine use in clinical practice [8, 9]. A large meta-analysis involving 17 studies published in 2004 showed that high expression of Ki-67 was associated with a poorer overall survival (hazard ratio (HR) 1.56, 95 % confidence interval (CI) 1.30–1.87), it did not evaluate the association between Ki-67 expression and disease-free survival. A further meta-analysis investigation is needed to delineate the relationship between Ki-67 expression and prognostic significance in NSCLC more clearly
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