Abstract
ObjectiveThis study sought to assess the prognostic role of Ki67 in primary ovarian high-grade serous carcinoma (HGSC) and to determine whether Ki67 expression can predict responsiveness to platinum and paclitaxel chemotherapy.ResultsA total of 318 women were included in the analysis and the median follow-up time was 48 months (range, 3–150 months). Ki67 proliferation indices ranged from 3% to 95% with a median of 40%. Using 40% as the cut-off value for the Ki67 index, we classified 141 patients as having low Ki67 expression and 177 patients as having high Ki67 expression. Low Ki67 expression was a predictor of platinum resistance (hazard ratio (HR) 2.85, 95% CI 1.43–5.98, P < 0.001). In the Kaplan-Meier analysis, comparisons of patients with low versus high Ki67 expression demonstrated that low Ki67 expression was significantly associated with decreased progression-free survival (PFS) (22% vs. 34% for 5-year PFS, P < 0.001) and decreased overall survival (OS) (31% vs. 55%, P < 0.001). Multivariate analysis indicated that low Ki67 expression was associated with decreased PFS (HR 2.98, 95% CI 1.75–6.56, P < 0.001) and decreased OS (HR 1.74, 95% CI 1.38–5.01, P = 0.003).Materials and MethodsA retrospective study of patients with stage I-IV primary ovarian HGSC was conducted from January 1, 2002, to December 31, 2012. Ki67 levels were measured via immunohistochemistry (IHC) and analyzed with respect to clinicopathological factors, and a survival analysis was performed.ConclusionsHGSC appears to be a heterogeneous disease with different clinical outcomes. Low Ki67 expression (< 40%) in HGSC is significantly associated with platinum resistance and decreased survival.
Highlights
Ovarian cancer accounts for only approximately 3% of cancer cases among women, it is one of the most deadly types of cancer
Low Ki67 expression was a predictor of platinum resistance (hazard ratio (HR) 2.85, 95% confidence intervals (CIs) 1.43–5.98, P < 0.001)
In the Kaplan-Meier analysis, comparisons of patients with low versus high Ki67 expression demonstrated that low Ki67 expression was significantly associated with decreased progressionfree survival (PFS) (22% vs. 34% for 5-year PFS, P < 0.001) and decreased overall survival (OS) (31% vs. 55%, P < 0.001)
Summary
Ovarian cancer accounts for only approximately 3% of cancer cases among women, it is one of the most deadly types of cancer. The most common form of epithelial ovarian cancer is high-grade serous cancer (HGSC), which accounts for 60–80% of cases of epithelial ovarian cancer and the majority of epithelial ovarian cancer-related deaths [2]. Recent data revealed that HGSC exhibits marked chromosomal aberrations and heterogeneous molecular and cellular biological characteristics [3,4,5,6]. These findings clearly indicate that one treatment will not be effective for all HGSC patients and challenge the “one-size-fitsall” concept with respect to treating HGSC. It is essential to identify predictors that can distinguish the subsets of HGSC patients with relatively good prognoses who could benefit from conventional adjuvant therapy from those with the greatest need for more aggressive treatment regimens and/or targeted therapy
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